05D2170609 CLIA NUMBER - MEMORIALCARE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2170609
  • Facility Name: MEMORIALCARE MEDICAL GROUP
  • Facility Address: 17251-B 17TH STREET
    TUSTIN, CA
    ZIP 92780
  • Facility Phone: 657 241-8580
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RACHIT DOSHI
  • NPI Number: 1720256415
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2170609
LAB Type Physician Office
Facility Name MEMORIALCARE MEDICAL GROUP
Street 17251-B 17TH STREET
City TUSTIN
State CA
ZIP 92780
Phone 657 241-8580
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2023
Certificate Expiration Date 8/13/2025
Facility Type Physician Office
Lab Director RACHIT DOSHI

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This page was last updated on: 6/4/2025