05D1094983 CLIA NUMBER - LUTHER MANGOBA MD INC

Laboratory Demographics

  • CLIA Code: 05D1094983
  • Facility Name: LUTHER MANGOBA MD INC
  • Facility Address: 9041 MAGNOLIA AVE STE 008
    RIVERSIDE, CA
    ZIP 92503
  • Facility Phone: 951 687-0004
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LUTHER B. MANGOBA MD
  • NPI Number: 1528041894
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1094983
LAB Type Physician Office
Facility Name LUTHER MANGOBA MD INC
Street 9041 MAGNOLIA AVE STE 008
City RIVERSIDE
State CA
ZIP 92503
Phone 951 687-0004
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2025
Certificate Expiration Date 1/29/2027
Facility Type Physician Office
Lab Director LUTHER B. MANGOBA MD

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