05D2078272 CLIA NUMBER - WHITNEY YOUNG FAMILY HEALTH CENTER

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Laboratory Demographics

CLIA Number: 05D2078272

Facility Name: WHITNEY YOUNG FAMILY HEALTH CENTER

Facility Address:
1755 MAPLE ST
SAN BERNARDINO, CA
ZIP 92411
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Facility Phone Number: 909 386-7600

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1255523759

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2078272
LAB Type	Federally Qualified Health Center
Facility Name	WHITNEY YOUNG FAMILY HEALTH CENTER
Street	1755 MAPLE ST
City	SAN BERNARDINO
State	CA
ZIP	92411
Phone	909 386-7600
CertificateType	4
CertificateEffectiveDate	5/23/2022
CertificateExpirationDate	5/22/2024
FacilityType	Waiver

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