05D2155658 CLIA NUMBER - INLAND EMPIRE WOMANS CENTER, MEDICAL ASSOCIATES

Laboratory Demographics

CLIA Number: 05D2155658

Facility Name: INLAND EMPIRE WOMANS CENTER, MEDICAL ASSOCIATES

Facility Address:
1364 N. WATERMAN AVENUE
SAN BERNARDINO, CA
ZIP 92404
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Facility Phone Number: 909 361-3061

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1972079572

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2155658
LAB Type	Physician Office
Facility Name	INLAND EMPIRE WOMANS CENTER, MEDICAL ASSOCIATES
Street	1364 N. WATERMAN AVENUE
City	SAN BERNARDINO
State	CA
ZIP	92404
Phone	909 361-3061
CertificateType	4
CertificateEffectiveDate	10/2/2022
CertificateExpirationDate	10/1/2024
FacilityType	Waiver

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