05D2160518 CLIA NUMBER - TELECARE MERRILL CENTER CSU

Laboratory Demographics

  • CLIA Code: 05D2160518
  • Facility Name: TELECARE MERRILL CENTER CSU
  • Facility Address: 14677 MERRILL AVENUE
    FONTANA, CA
    ZIP 92335
  • Facility Phone: 951 643-2337
  • Facility Type: Other - CRISIS STABILIZATION
  • Facility Type: Waiver
  • Lab Director: HAFIZULLAH AZIZI
  • NPI Number: 1376055632
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2160518
LAB Type Other - CRISIS STABILIZATION
Facility Name TELECARE MERRILL CENTER CSU
Street 14677 MERRILL AVENUE
City FONTANA
State CA
ZIP 92335
Phone 951 643-2337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2025
Certificate Expiration Date 1/10/2027
Facility Type Other - CRISIS STABILIZATION
Lab Director HAFIZULLAH AZIZI

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