05D2251795 CLIA NUMBER - PROVIDENCE CARDIOLOGY ORANGE

Laboratory Demographics

  • CLIA Code: 05D2251795
  • Facility Name: PROVIDENCE CARDIOLOGY ORANGE
  • Facility Address: 1140 W LA VETA AVE SUITE 430
    ORANGE, CA
    ZIP 92868
  • Facility Phone: 714 543-5555
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID PAN
  • NPI Number: 1871607762
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2251795
LAB Type Physician Office
Facility Name PROVIDENCE CARDIOLOGY ORANGE
Street 1140 W LA VETA AVE SUITE 430
City ORANGE
State CA
ZIP 92868
Phone 714 543-5555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2024
Certificate Expiration Date 2/5/2026
Facility Type Physician Office
Lab Director DAVID PAN

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