05D2179963 CLIA NUMBER - SUN MEDICAL GROUP, INC

Laboratory Demographics

CLIA Number: 05D2179963

Facility Name: SUN MEDICAL GROUP, INC

Facility Address:
27522 ANTONIO PARKWAY SUITE P3
LADERA RANCH, CA
ZIP 92694
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Facility Phone Number: 949 207-3786

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1114588704

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2179963
LAB Type	Physician Office
Facility Name	SUN MEDICAL GROUP, INC
Street	27522 ANTONIO PARKWAY SUITE P3
City	LADERA RANCH
State	CA
ZIP	92694
Phone	949 207-3786
CertificateType	4
CertificateEffectiveDate	3/4/2024
CertificateExpirationDate	3/3/2026
FacilityType	Waiver

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