05D2105813 CLIA NUMBER - GOLDSTAR PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 05D2105813
  • Facility Name: GOLDSTAR PEDIATRICS PC
  • Facility Address: 15290 SUMMIT AVE STE B
    FONTANA, CA
    ZIP 92336
  • Facility Phone: 909 225-1900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: IRMGARD TACKIE
  • NPI Number: 1427420009
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D2105813
LAB Type Physician Office
Facility Name GOLDSTAR PEDIATRICS PC
Street 15290 SUMMIT AVE STE B
City FONTANA
State CA
ZIP 92336
Phone 909 225-1900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2023
Certificate Expiration Date 12/2/2025
Facility Type Physician Office
Lab Director IRMGARD TACKIE

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