05D2095375 CLIA NUMBER - EASTVALE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2095375
  • Facility Name: EASTVALE MEDICAL GROUP
  • Facility Address: 12523 LIMONITE AVE STE 400
    MIRA LOMA, CA
    ZIP 91752
  • Facility Phone: 951 808-6300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOYCE P. LAZARUS
  • NPI Number: 1396403267
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2095375
LAB Type Physician Office
Facility Name EASTVALE MEDICAL GROUP
Street 12523 LIMONITE AVE STE 400
City MIRA LOMA
State CA
ZIP 91752
Phone 951 808-6300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/6/2025
Certificate Expiration Date 5/5/2027
Facility Type Physician Office
Lab Director JOYCE P. LAZARUS

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