05D2201816 CLIA NUMBER - SAN FERNANDO MENTAL HEALTH CENTER

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Laboratory Demographics

CLIA Number: 05D2201816

Facility Name: SAN FERNANDO MENTAL HEALTH CENTER

Facility Address:
10605 BALBOA BLVD SUITE 100
GRANADA HILLS, CA
ZIP 91344
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Facility Phone Number: 213 738-4725

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1699802488

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2201816
LAB Type	Community Clinic
Facility Name	SAN FERNANDO MENTAL HEALTH CENTER
Street	10605 BALBOA BLVD SUITE 100
City	GRANADA HILLS
State	CA
ZIP	91344
Phone	213 738-4725
CertificateType	4
CertificateEffectiveDate	11/23/2022
CertificateExpirationDate	11/22/2024
FacilityType	Waiver

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