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05D2152737 CLIA NUMBER - CHILDRENS PRIMARY CARE MEDICAL GROUP INC.

Laboratory Demographics

CLIA Number: 05D2152737

Facility Name: CHILDRENS PRIMARY CARE MEDICAL GROUP INC.

Facility Address:
25170 HANCOCK AVE STE 200
MURRIETA, CA
ZIP 92562
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Facility Phone Number: 951 461-9300

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1710065933

Taxonomy: 261QD1600X - Clinic/Center
An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).

CLIA Record

Field Name Field Value
CLIA Number 05D2152737
LAB Type Physician Office
Facility Name CHILDRENS PRIMARY CARE MEDICAL GROUP INC.
Street 25170 HANCOCK AVE STE 200
City MURRIETA
State CA
ZIP 92562
Phone 951 461-9300
CertificateType 4
CertificateEffectiveDate 8/16/2022
CertificateExpirationDate 8/15/2024
FacilityType Waiver

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