05D2048800 CLIA NUMBER - CLINICA SIERRA VISTA DBA WEST SHAW COMMUNITY HEALTH CENTER

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Laboratory Demographics

CLIA Number: 05D2048800

Facility Name: CLINICA SIERRA VISTA DBA WEST SHAW COMMUNITY HEALTH CENTER

Facility Address:
3645 W SHAW AVE, STE 101
FRESNO, CA
ZIP 93711
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Facility Phone Number: 559 457-6800

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1033486048

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2048800
LAB Type	Federally Qualified Health Center
Facility Name	CLINICA SIERRA VISTA DBA WEST SHAW COMMUNITY HEALTH CENTER
Street	3645 W SHAW AVE, STE 101
City	FRESNO
State	CA
ZIP	93711
Phone	559 457-6800
CertificateType	4
CertificateEffectiveDate	10/23/2022
CertificateExpirationDate	10/22/2024
FacilityType	Waiver

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