05D2096529 CLIA NUMBER - GREATER VALLEY PHYSICIANS MEDICAL GROUP

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Laboratory Demographics

CLIA Number: 05D2096529

Facility Name: GREATER VALLEY PHYSICIANS MEDICAL GROUP

Facility Address:
2219 S HACIENDA BLVD STE 101
HACIENDA HEIGHTS, CA
ZIP 91745
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Facility Phone Number: 626 338-8407

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053500991

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2096529
LAB Type	Physician Office
Facility Name	GREATER VALLEY PHYSICIANS MEDICAL GROUP
Street	2219 S HACIENDA BLVD STE 101
City	HACIENDA HEIGHTS
State	CA
ZIP	91745
Phone	626 338-8407
CertificateType	4
CertificateEffectiveDate	3/1/2024
CertificateExpirationDate	2/28/2026
FacilityType	Waiver

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