05D2101184 CLIA NUMBER - MED PED ID , INCORPORATED

Laboratory Demographics

  • CLIA Code: 05D2101184
  • Facility Name: MED PED ID , INCORPORATED
  • Facility Address: 28078 BAXTER RD STE 320
    MURRIETA, CA
    ZIP 92563
  • Facility Phone: 951 679-5811
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THUAN P. LE
  • NPI Number: 1245330364
  • Taxonomy: 207RI0200X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2101184
LAB Type Physician Office
Facility Name MED PED ID , INCORPORATED
Street 28078 BAXTER RD STE 320
City MURRIETA
State CA
ZIP 92563
Phone 951 679-5811
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2025
Certificate Expiration Date 8/27/2027
Facility Type Physician Office
Lab Director THUAN P. LE

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