05D2214077 CLIA NUMBER - IMPERIAL COUNTY PHYSICIANS MEDICAL GROUP CLINIC

Laboratory Demographics

  • CLIA Code: 05D2214077
  • Facility Name: IMPERIAL COUNTY PHYSICIANS MEDICAL GROUP CLINIC
  • Facility Address: 1503 NORTH IMPERIAL AVENUE SUITE 105A
    EL CENTRO, CA
    ZIP 92243
  • Facility Phone: (442) 231-8915
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLARA P. SPENCE
  • NPI Number: 1013516624
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2214077
LAB Type Physician Office
Facility Name IMPERIAL COUNTY PHYSICIANS MEDICAL GROUP CLINIC
Street 1503 NORTH IMPERIAL AVENUE SUITE 105A
City EL CENTRO
State CA
ZIP 92243
Phone 4422318915
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/18/2025
Certificate Expiration Date 2/17/2027
Facility Type Physician Office
Lab Director CLARA P. SPENCE

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This page was last updated on: 5/18/2026