05D2108598 CLIA NUMBER - SAN FERNANDO INTERNAL MEDICINE, INC

Laboratory Demographics

CLIA Number: 05D2108598

Facility Name: SAN FERNANDO INTERNAL MEDICINE, INC

Facility Address:
11550 INDIAN HILLS ROAD, #240
MISSION HILLS, CA
ZIP 91345
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Facility Phone Number: 818 488-5188

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1184081598

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2108598
LAB Type	Physician Office
Facility Name	SAN FERNANDO INTERNAL MEDICINE, INC
Street	11550 INDIAN HILLS ROAD, #240
City	MISSION HILLS
State	CA
ZIP	91345
Phone	818 488-5188
CertificateType	4
CertificateEffectiveDate	2/8/2024
CertificateExpirationDate	2/7/2026
FacilityType	Waiver

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