05D2189010 CLIA NUMBER - MACLAY WELLNESS CENTER

Laboratory Demographics

CLIA Number: 05D2189010

Facility Name: MACLAY WELLNESS CENTER

Facility Address:
12451 W GAIN STREET
PACOIMA, CA
ZIP 91331
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Facility Phone Number: 818 897-2193

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1053312587

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2189010
LAB Type	Federally Qualified Health Center
Facility Name	MACLAY WELLNESS CENTER
Street	12451 W GAIN STREET
City	PACOIMA
State	CA
ZIP	91331
Phone	818 897-2193
CertificateType	3
CertificateEffectiveDate	7/24/2022
CertificateExpirationDate	7/23/2024
FacilityType	PPMP

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