05D2079964 CLIA NUMBER - ALTAMED PACE-COVINA

Laboratory Demographics

CLIA Code: 05D2079964
Facility Name: ALTAMED PACE-COVINA
Facility Address: 535 S 2ND AVE
COVINA, CA
ZIP 91723
Facility Phone: 626 214-1480
Facility Type: Federally Qualified Health Center
Facility Type: Waiver
Lab Director: ESIQUIO G. CASILLAS MD
NPI Number: 1477975324
Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

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CLIA Record

Field Name	Field Value
CLIA Number	05D2079964
LAB Type	Federally Qualified Health Center
Facility Name	ALTAMED PACE-COVINA
Street	535 S 2ND AVE
City	COVINA
State	CA
ZIP	91723
Phone	626 214-1480
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/27/2024
Certificate Expiration Date	6/26/2026
Facility Type	Federally Qualified Health Center
Lab Director	ESIQUIO G. CASILLAS MD

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