05D2275216 CLIA NUMBER - ST. MARY HIGH DESERT CARDIAC REHAB

Laboratory Demographics

  • CLIA Code: 05D2275216
  • Facility Name: ST. MARY HIGH DESERT CARDIAC REHAB
  • Facility Address: 19341 BEAR VALLEY RD. #104
    APPLE VALLEY, CA
    ZIP 92308
  • Facility Phone: 760 956-4148
  • Facility Type: Other - CARDIAC REHAB
  • Facility Type: Waiver
  • Lab Director: MINO PHAM
  • NPI Number: 1588972806
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 05D2275216
LAB Type Other - CARDIAC REHAB
Facility Name ST. MARY HIGH DESERT CARDIAC REHAB
Street 19341 BEAR VALLEY RD. #104
City APPLE VALLEY
State CA
ZIP 92308
Phone 760 956-4148
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/18/2025
Certificate Expiration Date 1/17/2027
Facility Type Other - CARDIAC REHAB
Lab Director MINO PHAM

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