05D2029752 CLIA NUMBER - SAN JUAN MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2029752
  • Facility Name: SAN JUAN MEDICAL GROUP
  • Facility Address: 9916 SAN JUAN AVE
    SOUTH GATE, CA
    ZIP 90280
  • Facility Phone: 323 564-1100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIA LOURDES C. DE LEON
  • NPI Number: 1710261284
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2029752
LAB Type Physician Office
Facility Name SAN JUAN MEDICAL GROUP
Street 9916 SAN JUAN AVE
City SOUTH GATE
State CA
ZIP 90280
Phone 323 564-1100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/14/2025
Certificate Expiration Date 9/13/2027
Facility Type Physician Office
Lab Director MARIA LOURDES C. DE LEON

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