05D2160329 CLIA NUMBER - TAREK EZZEDDINE MD INC

Laboratory Demographics

  • CLIA Code: 05D2160329
  • Facility Name: TAREK EZZEDDINE MD INC
  • Facility Address: 10841 WHITE OAK AVENUE SUITE 103
    RANCHO CUCAMONGA, CA
    ZIP 91730
  • Facility Phone: 909 360-4722
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EZZEDDINE TAREK
  • NPI Number: 1548701287
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 05D2160329
LAB Type Physician Office
Facility Name TAREK EZZEDDINE MD INC
Street 10841 WHITE OAK AVENUE SUITE 103
City RANCHO CUCAMONGA
State CA
ZIP 91730
Phone 909 360-4722
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2025
Certificate Expiration Date 1/7/2027
Facility Type Physician Office
Lab Director EZZEDDINE TAREK

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