05D2257799 CLIA NUMBER - COMPREHENSIVE FAMILY CLINIC DBA LAKESIDE MEDICAL

Laboratory Demographics

  • CLIA Code: 05D2257799
  • Facility Name: COMPREHENSIVE FAMILY CLINIC DBA LAKESIDE MEDICAL
  • Facility Address: 2250 SOUTH RIVERSIDE AVE
    COLTON, CA
    ZIP 92324
  • Facility Phone: 801 974-3382
  • Facility Type: School/Student Health Service
  • Facility Type: Waiver
  • Lab Director: ERIC C. WELLING
  • NPI Number: 1528204922
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 05D2257799
LAB Type School/Student Health Service
Facility Name COMPREHENSIVE FAMILY CLINIC DBA LAKESIDE MEDICAL
Street 2250 SOUTH RIVERSIDE AVE
City COLTON
State CA
ZIP 92324
Phone 801 974-3382
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type School/Student Health Service
Lab Director ERIC C. WELLING

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