05D1088543 CLIA NUMBER - EMANATE HEALTH MEDICAL CARE FOUNDATION

Laboratory Demographics

  • CLIA Code: 05D1088543
  • Facility Name: EMANATE HEALTH MEDICAL CARE FOUNDATION
  • Facility Address: 210 S GRAND AVE STE 302
    GLENDORA, CA
    ZIP 91741
  • Facility Phone: 626 963-4149
  • Facility Type: Other - MEDICAL FOUNDATION
  • Facility Type: Waiver
  • Lab Director: LISA L. THOMSEN
  • NPI Number: 1174586960
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1088543
LAB Type Other - MEDICAL FOUNDATION
Facility Name EMANATE HEALTH MEDICAL CARE FOUNDATION
Street 210 S GRAND AVE STE 302
City GLENDORA
State CA
ZIP 91741
Phone 626 963-4149
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/27/2024
Certificate Expiration Date 8/26/2026
Facility Type Other - MEDICAL FOUNDATION
Lab Director LISA L. THOMSEN

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This page was last updated on: 9/29/2025