05D1100549 CLIA NUMBER - MEDICOR MEDICAL GROUP, INC

Laboratory Demographics

CLIA Number: 05D1100549

Facility Name: MEDICOR MEDICAL GROUP, INC

Facility Address:
7974 HAVEN AVE SUITE 250
RANCHO CUCAMONGA, CA
ZIP 91730
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Facility Phone Number: 909 941-0855

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1790863819

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	05D1100549
LAB Type	Physician Office
Facility Name	MEDICOR MEDICAL GROUP, INC
Street	7974 HAVEN AVE SUITE 250
City	RANCHO CUCAMONGA
State	CA
ZIP	91730
Phone	909 941-0855
CertificateType	4
CertificateEffectiveDate	6/8/2023
CertificateExpirationDate	6/7/2025
FacilityType	Waiver

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