05D2243362 CLIA NUMBER - PROVIDENCE TMC/CCC ORANGE

Laboratory Demographics

  • CLIA Code: 05D2243362
  • Facility Name: PROVIDENCE TMC/CCC ORANGE
  • Facility Address: 845 W LA VETA AVE STE 105
    ORANGE, CA
    ZIP 92868
  • Facility Phone: 714 402-3840
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SONAL SAKARIYA
  • NPI Number: 1184973752
  • Taxonomy: 273Y00000X - Rehabilitation Unit

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CLIA Record

Field Name Field Value
CLIA Number 05D2243362
LAB Type Physician Office
Facility Name PROVIDENCE TMC/CCC ORANGE
Street 845 W LA VETA AVE STE 105
City ORANGE
State CA
ZIP 92868
Phone 714 402-3840
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2023
Certificate Expiration Date 11/17/2025
Facility Type Physician Office
Lab Director SONAL SAKARIYA

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