05D1090297 CLIA NUMBER - PATRICK & EDIVINA GONZALES MED GROUP INC

Laboratory Demographics

  • CLIA Code: 05D1090297
  • Facility Name: PATRICK & EDIVINA GONZALES MED GROUP INC
  • Facility Address: 39755 DATE STREET # 103
    MURRIETA, CA
    ZIP 92563
  • Facility Phone: 951 304-3221
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDIVINA GONZALES MD
  • NPI Number: 1194784025
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 05D1090297
LAB Type Physician Office
Facility Name PATRICK & EDIVINA GONZALES MED GROUP INC
Street 39755 DATE STREET # 103
City MURRIETA
State CA
ZIP 92563
Phone 951 304-3221
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/7/2024
Certificate Expiration Date 10/6/2026
Facility Type Physician Office
Lab Director EDIVINA GONZALES MD

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