05D2010495 CLIA NUMBER - MIGUEL A DOMINGUEZ, MD INC

Laboratory Demographics

  • CLIA Code: 05D2010495
  • Facility Name: MIGUEL A DOMINGUEZ, MD INC
  • Facility Address: 18102 IRVINE BLVD STE 208
    TUSTIN, CA
    ZIP 92780
  • Facility Phone: 714 371-9000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MIGUEL DOMINGUEZ
  • NPI Number: 1235170556
  • Taxonomy: 207LP2900X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 05D2010495
LAB Type Physician Office
Facility Name MIGUEL A DOMINGUEZ, MD INC
Street 18102 IRVINE BLVD STE 208
City TUSTIN
State CA
ZIP 92780
Phone 714 371-9000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/29/2024
Certificate Expiration Date 7/28/2026
Facility Type Physician Office
Lab Director MIGUEL DOMINGUEZ

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