05D2090767 CLIA NUMBER - FREDERICKA MANOR CARE CENTER

Laboratory Demographics

  • CLIA Code: 05D2090767
  • Facility Name: FREDERICKA MANOR CARE CENTER
  • Facility Address: 111 THIRD AVENUE
    CHULA VISTA, CA
    ZIP 91910
  • Facility Phone: 619 427-2777
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: LUIS F. SANCHEZ
  • NPI Number: 1720335789
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2090767
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name FREDERICKA MANOR CARE CENTER
Street 111 THIRD AVENUE
City CHULA VISTA
State CA
ZIP 91910
Phone 619 427-2777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/29/2025
Certificate Expiration Date 1/28/2027
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director LUIS F. SANCHEZ

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