05D2172282 CLIA NUMBER - SERENITY MD CHINO

Laboratory Demographics

  • CLIA Code: 05D2172282
  • Facility Name: SERENITY MD CHINO
  • Facility Address: 4028 GRAND SUITE A
    CHINO, CA
    ZIP 91710
  • Facility Phone: 909 597-4528
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ROLAND FUERTEZ
  • NPI Number: 1144550971
  • Taxonomy: 101YA0400X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 05D2172282
LAB Type Practitioner Other
Facility Name SERENITY MD CHINO
Street 4028 GRAND SUITE A
City CHINO
State CA
ZIP 91710
Phone 909 597-4528
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2025
Certificate Expiration Date 9/17/2027
Facility Type Practitioner Other
Lab Director ROLAND FUERTEZ

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