05D2024906 CLIA NUMBER - MARQUE MEDICAL CLINIC, INC DBA MARQUE URGENT CARE

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Laboratory Demographics

CLIA Number: 05D2024906

Facility Name: MARQUE MEDICAL CLINIC, INC DBA MARQUE URGENT CARE

Facility Address:
4085 GOVERNOR DR.
SAN DIEGO, CA
ZIP 92122
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Facility Phone Number: 949 790-9222

Facility Type: Other - URGENT CARE CLINIC

Certificate Type: Waiver

NPI Number: 1174180533

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2024906
LAB Type	Other - URGENT CARE CLINIC
Facility Name	MARQUE MEDICAL CLINIC, INC DBA MARQUE URGENT CARE
Street	4085 GOVERNOR DR.
City	SAN DIEGO
State	CA
ZIP	92122
Phone	949 790-9222
CertificateType	4
CertificateEffectiveDate	3/13/2023
CertificateExpirationDate	3/12/2025
FacilityType	Waiver

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