05D2165354 CLIA NUMBER - PRIORITY CARE MEDICAL GROUP VAN NUYS

Laboratory Demographics

CLIA Number: 05D2165354

Facility Name: PRIORITY CARE MEDICAL GROUP VAN NUYS

Facility Address:
14407 HAMLIN ST STE B
VAN NUYS, CA
ZIP 91401
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Facility Phone Number: 818 781-2330

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1700350659

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2165354
LAB Type	Federally Qualified Health Center
Facility Name	PRIORITY CARE MEDICAL GROUP VAN NUYS
Street	14407 HAMLIN ST STE B
City	VAN NUYS
State	CA
ZIP	91401
Phone	818 781-2330
CertificateType	4
CertificateEffectiveDate	4/25/2023
CertificateExpirationDate	4/24/2025
FacilityType	Waiver

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