05D2230664 CLIA NUMBER - PHANTOM MEDICAL, INC

Laboratory Demographics

CLIA Number: 05D2230664

Facility Name: PHANTOM MEDICAL, INC

Facility Address:
1240 E CHAPMAN AVE SUITE A
ORANGE, CA
ZIP 92866
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Facility Phone Number: 714 771-2800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1790390052

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	05D2230664
LAB Type	Physician Office
Facility Name	PHANTOM MEDICAL, INC
Street	1240 E CHAPMAN AVE SUITE A
City	ORANGE
State	CA
ZIP	92866
Phone	714 771-2800
CertificateType	4
CertificateEffectiveDate	7/27/2023
CertificateExpirationDate	7/26/2025
FacilityType	Waiver

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