05D2137485 CLIA NUMBER - BOLD HEALTH MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D2137485

Facility Name: BOLD HEALTH MEDICAL GROUP

Facility Address:
561 SAXONY PLACE STE 101
ENCINITAS, CA
ZIP 92024
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Facility Phone Number: 760 704-9429

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1245749688

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2137485
LAB Type	Physician Office
Facility Name	BOLD HEALTH MEDICAL GROUP
Street	561 SAXONY PLACE STE 101
City	ENCINITAS
State	CA
ZIP	92024
Phone	760 704-9429
CertificateType	4
CertificateEffectiveDate	9/27/2023
CertificateExpirationDate	9/26/2025
FacilityType	Waiver

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