05D2118159 CLIA NUMBER - EMANATE HEALTH IMAGING

Laboratory Demographics

  • CLIA Code: 05D2118159
  • Facility Name: EMANATE HEALTH IMAGING
  • Facility Address: 828 S GRAND AVE STE 104
    GLENDORA, CA
    ZIP 91740
  • Facility Phone: 626 963-2057
  • Facility Type: Other - IMAGING CENTER
  • Facility Type: Waiver
  • Lab Director: DAVID UNDERWOOD
  • NPI Number: 1093240004
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 05D2118159
LAB Type Other - IMAGING CENTER
Facility Name EMANATE HEALTH IMAGING
Street 828 S GRAND AVE STE 104
City GLENDORA
State CA
ZIP 91740
Phone 626 963-2057
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2024
Certificate Expiration Date 8/30/2026
Facility Type Other - IMAGING CENTER
Lab Director DAVID UNDERWOOD

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