05D1085248 CLIA NUMBER - CLINICA MEDICA DEL VALLE

Laboratory Demographics

CLIA Number: 05D1085248

Facility Name: CLINICA MEDICA DEL VALLE

Facility Address:
52-565 HARRISON STREET SUITE 104
COACHELLA, CA
ZIP 92236
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Facility Phone Number: 760 398-0606

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1790921641

Taxonomy: 2086S0120X - Surgery
A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.

CLIA Record

Field Name	Field Value
CLIA Number	05D1085248
LAB Type	Physician Office
Facility Name	CLINICA MEDICA DEL VALLE
Street	52-565 HARRISON STREET SUITE 104
City	COACHELLA
State	CA
ZIP	92236
Phone	760 398-0606
CertificateType	4
CertificateEffectiveDate	6/12/2022
CertificateExpirationDate	6/11/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024