05D2261530 CLIA NUMBER - EXECUTIVE URGENT CARE CENTERS INC

Laboratory Demographics

CLIA Number: 05D2261530

Facility Name: EXECUTIVE URGENT CARE CENTERS INC

Facility Address:
74785 HWY 111 STE 100
INDIAN WELLS, CA
ZIP 92210
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Facility Phone Number: 760 346-3932

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1801181961

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2261530
LAB Type	Physician Office
Facility Name	EXECUTIVE URGENT CARE CENTERS INC
Street	74785 HWY 111 STE 100
City	INDIAN WELLS
State	CA
ZIP	92210
Phone	760 346-3932
CertificateType	4
CertificateEffectiveDate	6/1/2022
CertificateExpirationDate	5/31/2024
FacilityType	Waiver

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