05D2240625 CLIA NUMBER - MORENO VALLEY COMMUNITY MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D2240625

Facility Name: MORENO VALLEY COMMUNITY MEDICAL GROUP

Facility Address:
23180 HEMLOCK AVE SUITE 201
MORENO VALLEY, CA
ZIP 92557
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Facility Phone Number: 951 243-6460

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1437595873

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2240625
LAB Type	Physician Office
Facility Name	MORENO VALLEY COMMUNITY MEDICAL GROUP
Street	23180 HEMLOCK AVE SUITE 201
City	MORENO VALLEY
State	CA
ZIP	92557
Phone	951 243-6460
CertificateType	4
CertificateEffectiveDate	10/20/2023
CertificateExpirationDate	10/19/2025
FacilityType	Waiver

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