05D2065203 CLIA NUMBER - NIVERA ENTERPRISES, INC DBA SAN GABRIEL HOSPICE

Laboratory Demographics

  • CLIA Code: 05D2065203
  • Facility Name: NIVERA ENTERPRISES, INC DBA SAN GABRIEL HOSPICE
  • Facility Address: 1152 E ROUTE 66 SAN GABRIEL HOSPICE
    GLENDORA, CA
    ZIP 91740
  • Facility Phone: 626 335-2171
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: PETER N. MATTAR
  • NPI Number: 1194090563
  • Taxonomy: 251G00000X - Hospice Care, Community Based

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D2065203
LAB Type Hospice
Facility Name NIVERA ENTERPRISES, INC DBA SAN GABRIEL HOSPICE
Street 1152 E ROUTE 66 SAN GABRIEL HOSPICE
City GLENDORA
State CA
ZIP 91740
Phone 626 335-2171
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2025
Certificate Expiration Date 9/4/2027
Facility Type Hospice
Lab Director PETER N. MATTAR

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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