05D2073701 CLIA NUMBER - SOUTH VALLEY MULTI SPECIALTY MEDICAL GROUP, INC

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Laboratory Demographics

CLIA Number: 05D2073701

Facility Name: SOUTH VALLEY MULTI SPECIALTY MEDICAL GROUP, INC

Facility Address:
173 N. MORRISON AVE STE C
SAN JOSE, CA
ZIP 95126
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Facility Phone Number: 408 293-1992

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1215991583

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	05D2073701
LAB Type	Physician Office
Facility Name	SOUTH VALLEY MULTI SPECIALTY MEDICAL GROUP, INC
Street	173 N. MORRISON AVE STE C
City	SAN JOSE
State	CA
ZIP	95126
Phone	408 293-1992
CertificateType	4
CertificateEffectiveDate	2/24/2024
CertificateExpirationDate	2/23/2026
FacilityType	Waiver

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