05D2155285 CLIA NUMBER - FOOTHILL COMMUNITY MEDICAL CORPORATION SAN RAFAEL COMMUNITY MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 05D2155285
  • Facility Name: FOOTHILL COMMUNITY MEDICAL CORPORATION SAN RAFAEL COMMUNITY MEDICAL CLINIC
  • Facility Address: 1400 N HACIENDA BLVD
    LA PUENTE, CA
    ZIP 91744
  • Facility Phone: 626 931-2200
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: RAFAEL CARCAMO
  • NPI Number: 1841767415
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2155285
LAB Type Practitioner Other
Facility Name FOOTHILL COMMUNITY MEDICAL CORPORATION SAN RAFAEL COMMUNITY MEDICAL CLINIC
Street 1400 N HACIENDA BLVD
City LA PUENTE
State CA
ZIP 91744
Phone 626 931-2200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2024
Certificate Expiration Date 9/25/2026
Facility Type Practitioner Other
Lab Director RAFAEL CARCAMO

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