05D2133704 CLIA NUMBER - MISSION UROLOGY

Laboratory Demographics

  • CLIA Code: 05D2133704
  • Facility Name: MISSION UROLOGY
  • Facility Address: 4500 BROCKTON AVE STE 301
    RIVERSIDE, CA
    ZIP 92501
  • Facility Phone: 951 276-4505
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: TIMOTHY J. PIETRO
  • NPI Number: 1063874337
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 05D2133704
LAB Type Physician Office
Facility Name MISSION UROLOGY
Street 4500 BROCKTON AVE STE 301
City RIVERSIDE
State CA
ZIP 92501
Phone 951 276-4505
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/18/2025
Certificate Expiration Date 7/17/2027
Facility Type Physician Office
Lab Director TIMOTHY J. PIETRO

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