05D2258185 CLIA NUMBER - BEAVER MEDICAL GROUP, PC ENT RED

Laboratory Demographics

  • CLIA Code: 05D2258185
  • Facility Name: BEAVER MEDICAL GROUP, PC ENT RED
  • Facility Address: 259 TERRACINA BLVD
    REDLANDS, CA
    ZIP 92373
  • Facility Phone: 909 786-0844
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: ALVIN UMEDA
  • NPI Number: 1790029759
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 05D2258185
LAB Type Ancillary Testing Site in Health Care Center
Facility Name BEAVER MEDICAL GROUP, PC ENT RED
Street 259 TERRACINA BLVD
City REDLANDS
State CA
ZIP 92373
Phone 909 786-0844
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2024
Certificate Expiration Date 4/17/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director ALVIN UMEDA

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