05D2201820 CLIA NUMBER - PALMDALE MENTAL HEALTH CENTER

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Laboratory Demographics

CLIA Number: 05D2201820

Facility Name: PALMDALE MENTAL HEALTH CENTER

Facility Address:
1529 EAST PALMDALE BLVD SUITE 150
PALMDALE, CA
ZIP 93550
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Facility Phone Number: 213 738-4725

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1881627420

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2201820
LAB Type	Community Clinic
Facility Name	PALMDALE MENTAL HEALTH CENTER
Street	1529 EAST PALMDALE BLVD SUITE 150
City	PALMDALE
State	CA
ZIP	93550
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