05D2153171 CLIA NUMBER - HOAG URGENT CARE TUSTIN LEGACY

Laboratory Demographics

CLIA Number: 05D2153171

Facility Name: HOAG URGENT CARE TUSTIN LEGACY

Facility Address:
15000 KENSINGTON PARK DR STE 170
TUSTIN, CA
ZIP 92782
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Facility Phone Number: 949 791-3065

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346559879

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2153171
LAB Type	Physician Office
Facility Name	HOAG URGENT CARE TUSTIN LEGACY
Street	15000 KENSINGTON PARK DR STE 170
City	TUSTIN
State	CA
ZIP	92782
Phone	949 791-3065
CertificateType	4
CertificateEffectiveDate	8/22/2022
CertificateExpirationDate	8/21/2024
FacilityType	Waiver

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