05D2030474 CLIA NUMBER - SOUTHERN CALIFORNIA PRIMARY MEDICAL INC

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Laboratory Demographics

CLIA Number: 05D2030474

Facility Name: SOUTHERN CALIFORNIA PRIMARY MEDICAL INC

Facility Address:
19341 BEAR VALLEY RD STE 101
APPLE VALLEY, CA
ZIP 92308
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Facility Phone Number: 760 810-7778

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1043508559

Taxonomy: 207QG0300X - Family Medicine
A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.

CLIA Record

Field Name	Field Value
CLIA Number	05D2030474
LAB Type	Physician Office
Facility Name	SOUTHERN CALIFORNIA PRIMARY MEDICAL INC
Street	19341 BEAR VALLEY RD STE 101
City	APPLE VALLEY
State	CA
ZIP	92308
Phone	760 810-7778
CertificateType	4
CertificateEffectiveDate	4/3/2023
CertificateExpirationDate	4/2/2025
FacilityType	Waiver

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