05D1100215 CLIA NUMBER - ADVANCED PAIN MANAGEMENT CENTER

Laboratory Demographics

  • CLIA Code: 05D1100215
  • Facility Name: ADVANCED PAIN MANAGEMENT CENTER
  • Facility Address: 15447 W SAND STREET
    VICTORVILLE, CA
    ZIP 92392
  • Facility Phone: 760 843-9679
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOE PARK, MD
  • NPI Number: 1821186776
  • Taxonomy: 207LP2900X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 05D1100215
LAB Type Physician Office
Facility Name ADVANCED PAIN MANAGEMENT CENTER
Street 15447 W SAND STREET
City VICTORVILLE
State CA
ZIP 92392
Phone 760 843-9679
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/2/2025
Certificate Expiration Date 6/1/2027
Facility Type Physician Office
Lab Director JOE PARK, MD

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