05D2030472 CLIA NUMBER - ALTAMED MEDICAL GROUP - WEST COVINA

Laboratory Demographics

  • CLIA Code: 05D2030472
  • Facility Name: ALTAMED MEDICAL GROUP - WEST COVINA
  • Facility Address: 1300 S SUNSET AVE
    WEST COVINA, CA
    ZIP 91790
  • Facility Phone: 626 214-7404
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DAT TRINH
  • NPI Number: 1245608959
  • Taxonomy: 251B00000X - Case Management

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CLIA Record

Field Name Field Value
CLIA Number 05D2030472
LAB Type Federally Qualified Health Center
Facility Name ALTAMED MEDICAL GROUP - WEST COVINA
Street 1300 S SUNSET AVE
City WEST COVINA
State CA
ZIP 91790
Phone 626 214-7404
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/28/2025
Certificate Expiration Date 9/27/2027
Facility Type Federally Qualified Health Center
Lab Director DAT TRINH

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