05D2230307 CLIA NUMBER - DAVID R JENSEN MD FIRST VALLEY MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D2230307

Facility Name: DAVID R JENSEN MD FIRST VALLEY MEDICAL GROUP

Facility Address:
619 W AVE Q STE B
PALMDALE, CA
ZIP 93551
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Facility Phone Number: 661 273-2556

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1093731325

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	05D2230307
LAB Type	Physician Office
Facility Name	DAVID R JENSEN MD FIRST VALLEY MEDICAL GROUP
Street	619 W AVE Q STE B
City	PALMDALE
State	CA
ZIP	93551
Phone	661 273-2556
CertificateType	4
CertificateEffectiveDate	7/21/2023
CertificateExpirationDate	7/20/2025
FacilityType	Waiver

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