05D2009969 CLIA NUMBER - VICTORIA ONE HOSPICE INC

Laboratory Demographics

  • CLIA Code: 05D2009969
  • Facility Name: VICTORIA ONE HOSPICE INC
  • Facility Address: 510 E FOOTHILL BLVD STE 106
    SAN DIMAS, CA
    ZIP 91773
  • Facility Phone: 909 599-0055
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: LEONIDAS V. MEJIA
  • NPI Number: 1467770263
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2009969
LAB Type Hospice
Facility Name VICTORIA ONE HOSPICE INC
Street 510 E FOOTHILL BLVD STE 106
City SAN DIMAS
State CA
ZIP 91773
Phone 909 599-0055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2024
Certificate Expiration Date 12/1/2026
Facility Type Hospice
Lab Director LEONIDAS V. MEJIA

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