05D2188393 CLIA NUMBER - MARIPOSA COMMUNITY COUNSELING

Laboratory Demographics

CLIA Number: 05D2188393

Facility Name: MARIPOSA COMMUNITY COUNSELING

Facility Address:
2940 INLAND EMPIRE BLVD
ONTARIO, CA
ZIP 91764
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Facility Phone Number: 909 386-9740

Facility Type: Other - COMM OUTPATIENT CLINIC

Certificate Type: Waiver

NPI Number: 1962612549

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2188393
LAB Type	Other - COMM OUTPATIENT CLINIC
Facility Name	MARIPOSA COMMUNITY COUNSELING
Street	2940 INLAND EMPIRE BLVD
City	ONTARIO
State	CA
ZIP	91764
Phone	909 386-9740
CertificateType	4
CertificateEffectiveDate	7/16/2022
CertificateExpirationDate	7/15/2024
FacilityType	Waiver

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