05D2056116 CLIA NUMBER - SOLEDAD HOUSE 1

Laboratory Demographics

  • CLIA Code: 05D2056116
  • Facility Name: SOLEDAD HOUSE 1
  • Facility Address: 4747 MORENA BLVD STE 200
    SAN DIEGO, CA
    ZIP 92117
  • Facility Phone: 619 346-3904
  • Facility Type: Other - TREATMENT FACILTY INPATIE
  • Facility Type: Waiver
  • Lab Director: JOHN W. ALLEN
  • NPI Number: 1447898473
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2056116
LAB Type Other - TREATMENT FACILTY INPATIE
Facility Name SOLEDAD HOUSE 1
Street 4747 MORENA BLVD STE 200
City SAN DIEGO
State CA
ZIP 92117
Phone 619 346-3904
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2025
Certificate Expiration Date 8/14/2027
Facility Type Other - TREATMENT FACILTY INPATIE
Lab Director JOHN W. ALLEN

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