05D2198098 CLIA NUMBER - FOOTHILLS PEDIATRIC AND ADOLESCENT CLINIC

Laboratory Demographics

  • CLIA Code: 05D2198098
  • Facility Name: FOOTHILLS PEDIATRIC AND ADOLESCENT CLINIC
  • Facility Address: 1330 W COVINA BLVD STE 106
    SAN DIMAS, CA
    ZIP 91773
  • Facility Phone: 909 599-6876
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL MADANAT
  • NPI Number: 1952499378
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D2198098
LAB Type Physician Office
Facility Name FOOTHILLS PEDIATRIC AND ADOLESCENT CLINIC
Street 1330 W COVINA BLVD STE 106
City SAN DIMAS
State CA
ZIP 91773
Phone 909 599-6876
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2024
Certificate Expiration Date 10/28/2026
Facility Type Physician Office
Lab Director MICHAEL MADANAT

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