05D2262626 CLIA NUMBER - MARQUE MEDICAL CLINIC INC DBA MARQUE URGENT CARE

Laboratory Demographics

  • CLIA Code: 05D2262626
  • Facility Name: MARQUE MEDICAL CLINIC INC DBA MARQUE URGENT CARE
  • Facility Address: 21771 LAKE FOREST DR STE 109
    LAKE FOREST, CA
    ZIP 92630
  • Facility Phone: 877 693-6266
  • Facility Type: Other - URGENT CARE PHYSICIAN OFF
  • Facility Type: Waiver
  • Lab Director: NATHAN A. KISKILA
  • NPI Number: 1013625706
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2262626
LAB Type Other - URGENT CARE PHYSICIAN OFF
Facility Name MARQUE MEDICAL CLINIC INC DBA MARQUE URGENT CARE
Street 21771 LAKE FOREST DR STE 109
City LAKE FOREST
State CA
ZIP 92630
Phone 877 693-6266
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/15/2024
Certificate Expiration Date 6/14/2026
Facility Type Other - URGENT CARE PHYSICIAN OFF
Lab Director NATHAN A. KISKILA

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