05D2083333 CLIA NUMBER - ANITA JACKSON MD

Laboratory Demographics

  • CLIA Code: 05D2083333
  • Facility Name: ANITA JACKSON MD
  • Facility Address: 31736 MISSION TRL STE G
    LAKE ELSINORE, CA
    ZIP 92530
  • Facility Phone: 951 674-1505
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANITA JACKSON, MD
  • NPI Number: 1063519486
  • Taxonomy: 207QA0505X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2083333
LAB Type Physician Office
Facility Name ANITA JACKSON MD
Street 31736 MISSION TRL STE G
City LAKE ELSINORE
State CA
ZIP 92530
Phone 951 674-1505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/3/2024
Certificate Expiration Date 9/2/2026
Facility Type Physician Office
Lab Director ANITA JACKSON, MD

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