05D2065427 CLIA NUMBER - RANCHO CUCAMONGA HOME TRAINING

Laboratory Demographics

  • CLIA Code: 05D2065427
  • Facility Name: RANCHO CUCAMONGA HOME TRAINING
  • Facility Address: 8219 ROCHESTER AVENUE, SUITE 120
    RANCHO CUCAMONGA, CA
    ZIP 91730
  • Facility Phone: 909 466-5489
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: PATRICIA BLAKELY MD
  • NPI Number: 1497095905
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2065427
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name RANCHO CUCAMONGA HOME TRAINING
Street 8219 ROCHESTER AVENUE, SUITE 120
City RANCHO CUCAMONGA
State CA
ZIP 91730
Phone 909 466-5489
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/9/2025
Certificate Expiration Date 9/8/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director PATRICIA BLAKELY MD

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