05D2197090 CLIA NUMBER - BROADWAY MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 05D2197090
  • Facility Name: BROADWAY MEDICAL CLINIC
  • Facility Address: 1351 BROADWAY
    EL CAJON, CA
    ZIP 92021
  • Facility Phone: 301 466-1078
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JIMI BENSON
  • NPI Number: 1275936270
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2197090
LAB Type Physician Office
Facility Name BROADWAY MEDICAL CLINIC
Street 1351 BROADWAY
City EL CAJON
State CA
ZIP 92021
Phone 301 466-1078
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2024
Certificate Expiration Date 10/20/2026
Facility Type Physician Office
Lab Director JIMI BENSON

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