05D2111420 CLIA NUMBER - IMPACT CARE ACCESS NETWORK INC

Laboratory Demographics

  • CLIA Code: 05D2111420
  • Facility Name: IMPACT CARE ACCESS NETWORK INC
  • Facility Address: 9390 HESPERIA RD STE 7
    HESPERIA, CA
    ZIP 92345
  • Facility Phone: 760 998-2125
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PHILIP D. KOUROS, MD
  • NPI Number: 1861858904
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2111420
LAB Type Physician Office
Facility Name IMPACT CARE ACCESS NETWORK INC
Street 9390 HESPERIA RD STE 7
City HESPERIA
State CA
ZIP 92345
Phone 760 998-2125
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2024
Certificate Expiration Date 4/5/2026
Facility Type Physician Office
Lab Director PHILIP D. KOUROS, MD

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This page was last updated on: 3/20/2025