05D2211564 CLIA NUMBER - REGENERATIVE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2211564
  • Facility Name: REGENERATIVE MEDICAL GROUP
  • Facility Address: 12620 BROOKHURST ST STE 2
    GARDEN GROVE, CA
    ZIP 92840
  • Facility Phone: 714 551-9576
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD RUTLEDGE
  • NPI Number: 1881104222
  • Taxonomy: 207QG0300X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2211564
LAB Type Physician Office
Facility Name REGENERATIVE MEDICAL GROUP
Street 12620 BROOKHURST ST STE 2
City GARDEN GROVE
State CA
ZIP 92840
Phone 714 551-9576
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2025
Certificate Expiration Date 1/27/2027
Facility Type Physician Office
Lab Director RICHARD RUTLEDGE

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