05D2107667 CLIA NUMBER - COMMUNITY MEDICAL WELLNESS CENTERS, USA

Laboratory Demographics

CLIA Number: 05D2107667

Facility Name: COMMUNITY MEDICAL WELLNESS CENTERS, USA

Facility Address:
1360 E ANAHEIM ST STE 101
LONG BEACH, CA
ZIP 90813
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Facility Phone Number: 310 200-7636

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1235500513

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2107667
LAB Type	Federally Qualified Health Center
Facility Name	COMMUNITY MEDICAL WELLNESS CENTERS, USA
Street	1360 E ANAHEIM ST STE 101
City	LONG BEACH
State	CA
ZIP	90813
Phone	310 200-7636
CertificateType	4
CertificateEffectiveDate	1/20/2024
CertificateExpirationDate	1/19/2026
FacilityType	Waiver

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