05D2198486 CLIA NUMBER - ETN MEDICAL INFUSION CENTER

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Laboratory Demographics

CLIA Number: 05D2198486

Facility Name: ETN MEDICAL INFUSION CENTER

Facility Address:
11100 WARNER AVE SUITE #158
FOUNTAIN VALLEY, CA
ZIP 92708
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Facility Phone Number: 949 812-9907

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1972904084

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D2198486
LAB Type	Physician Office
Facility Name	ETN MEDICAL INFUSION CENTER
Street	11100 WARNER AVE SUITE #158
City	FOUNTAIN VALLEY
State	CA
ZIP	92708
Phone	949 812-9907
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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