05D2058283 CLIA NUMBER - PROVIDENCE GARDEN GROVE

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Laboratory Demographics

CLIA Number: 05D2058283

Facility Name: PROVIDENCE GARDEN GROVE

Facility Address:
12942 HARBOR BLVD
GARDEN GROVE, CA
ZIP 92840
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Facility Phone Number: (714) 705-1220

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

CLIA Record

Field Name	Field Value
CLIA Number	05D2058283
LAB Type	PHYSICIAN OFFICE
Facility Name	PROVIDENCE GARDEN GROVE
Street	12942 HARBOR BLVD
City	GARDEN GROVE
State	CA
ZIP	92840
Phone	(714) 705-1220

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This page was last updated on: 5/11/2023