05D2078948 CLIA NUMBER - GOLDOME HEALTHCARE INC

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Laboratory Demographics

CLIA Number: 05D2078948

Facility Name: GOLDOME HEALTHCARE INC

Facility Address:
2705 S DIAMOND BAR BLVD #100
DIAMOND BAR, CA
ZIP 91765
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Facility Phone Number: 626 667-8290

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295154672

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2078948
LAB Type	Physician Office
Facility Name	GOLDOME HEALTHCARE INC
Street	2705 S DIAMOND BAR BLVD #100
City	DIAMOND BAR
State	CA
ZIP	91765
Phone	626 667-8290
CertificateType	4
CertificateEffectiveDate	6/6/2022
CertificateExpirationDate	6/5/2024
FacilityType	Waiver

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