05D2196999 CLIA NUMBER - UNITED HEALTH CENTERS OF SAN JUAN JOAQUIN - CLOVIS HERNDON, THE

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Laboratory Demographics

CLIA Number: 05D2196999

Facility Name: UNITED HEALTH CENTERS OF SAN JUAN JOAQUIN - CLOVIS HERNDON, THE

Facility Address:
2497 EAST HERNDON AVENUE SUITE 103
CLOVIS, CA
ZIP 93611
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Facility Phone Number: 559 646-6618

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1558632570

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2196999
LAB Type	Federally Qualified Health Center
Facility Name	UNITED HEALTH CENTERS OF SAN JUAN JOAQUIN - CLOVIS HERNDON, THE
Street	2497 EAST HERNDON AVENUE SUITE 103
City	CLOVIS
State	CA
ZIP	93611
Phone	559 646-6618
CertificateType	4
CertificateEffectiveDate	10/21/2022
CertificateExpirationDate	10/20/2024
FacilityType	Waiver

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