05D2126182 CLIA NUMBER - CENTRO MEDICO DEL CARMEN

Laboratory Demographics

CLIA Number: 05D2126182

Facility Name: CENTRO MEDICO DEL CARMEN

Facility Address:
13373 PERRIS BLVD STE C202A
MORENO VALLEY, CA
ZIP 92553
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Facility Phone Number: 951 242-8155

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821532508

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	05D2126182
LAB Type	Physician Office
Facility Name	CENTRO MEDICO DEL CARMEN
Street	13373 PERRIS BLVD STE C202A
City	MORENO VALLEY
State	CA
ZIP	92553
Phone	951 242-8155
CertificateType	4
CertificateEffectiveDate	2/21/2023
CertificateExpirationDate	2/20/2025
FacilityType	Waiver

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