05D2204887 CLIA NUMBER - NUCLEUS MEDICAL GROUP, INC.

Laboratory Demographics

  • CLIA Code: 05D2204887
  • Facility Name: NUCLEUS MEDICAL GROUP, INC.
  • Facility Address: 4570 EXECUTIVE DR, SUITE 100
    SAN DIEGO, CA
    ZIP 92121
  • Facility Phone: 858 295-4892
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: KEITH K. VAUX
  • NPI Number: 1003402264
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2204887
LAB Type Ancillary Testing Site in Health Care Center
Facility Name NUCLEUS MEDICAL GROUP, INC.
Street 4570 EXECUTIVE DR, SUITE 100
City SAN DIEGO
State CA
ZIP 92121
Phone 858 295-4892
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/10/2024
Certificate Expiration Date 12/9/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director KEITH K. VAUX

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