05D1101710 CLIA NUMBER - GERARDO CANCHOLA, MD INC

Laboratory Demographics

  • CLIA Code: 05D1101710
  • Facility Name: GERARDO CANCHOLA, MD INC
  • Facility Address: 2621 S BRISTOL ST #308
    SANTA ANA, CA
    ZIP 92706
  • Facility Phone: 714 662-7710
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GERARDO CANCHOLA
  • NPI Number: 1639185879
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1101710
LAB Type Physician Office
Facility Name GERARDO CANCHOLA, MD INC
Street 2621 S BRISTOL ST #308
City SANTA ANA
State CA
ZIP 92706
Phone 714 662-7710
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2025
Certificate Expiration Date 7/1/2027
Facility Type Physician Office
Lab Director GERARDO CANCHOLA

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