05D2202596 CLIA NUMBER - CARBON HEALTH MEDICAL GROUP OF CALIFORNIA, PC DBA CARBON HEALTH

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Laboratory Demographics

CLIA Number: 05D2202596

Facility Name: CARBON HEALTH MEDICAL GROUP OF CALIFORNIA, PC DBA CARBON HEALTH

Facility Address:
14117 LIMONITE AVE, BUILDING 2, STE 300
EASTVALE, CA
ZIP 91752
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Facility Phone Number: 951 210-7237

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932840345

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2202596
LAB Type	Physician Office
Facility Name	CARBON HEALTH MEDICAL GROUP OF CALIFORNIA, PC DBA CARBON HEALTH
Street	14117 LIMONITE AVE, BUILDING 2, STE 300
City	EASTVALE
State	CA
ZIP	91752
Phone	951 210-7237
CertificateType	4
CertificateEffectiveDate	11/30/2022
CertificateExpirationDate	11/29/2024
FacilityType	Waiver

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