05D2091246 CLIA NUMBER - BARSTOW INDIAN HEALTH CLINIC

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Laboratory Demographics

CLIA Number: 05D2091246

Facility Name: BARSTOW INDIAN HEALTH CLINIC

Facility Address:
170 YUCCA AVE
BARSTOW, CA
ZIP 92311
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Facility Phone Number: 800 732-8805

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1699108894

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2091246
LAB Type	Federally Qualified Health Center
Facility Name	BARSTOW INDIAN HEALTH CLINIC
Street	170 YUCCA AVE
City	BARSTOW
State	CA
ZIP	92311
Phone	800 732-8805
CertificateType	4
CertificateEffectiveDate	2/9/2023
CertificateExpirationDate	2/8/2025
FacilityType	Waiver

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