05D1092500 CLIA NUMBER - DIGNITY HEALTH MEDICAL FOUNDATION

Laboratory Demographics

CLIA Number: 05D1092500

Facility Name: DIGNITY HEALTH MEDICAL FOUNDATION

Facility Address:
17051 SIERRA LAKES PARKWAY STE 101
FONTANA, CA
ZIP 92336
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Facility Phone Number: 909 428-2040

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1780226852

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1092500
LAB Type	Physician Office
Facility Name	DIGNITY HEALTH MEDICAL FOUNDATION
Street	17051 SIERRA LAKES PARKWAY STE 101
City	FONTANA
State	CA
ZIP	92336
Phone	909 428-2040
CertificateType	3
CertificateEffectiveDate	11/25/2022
CertificateExpirationDate	11/24/2024
FacilityType	PPMP

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