05D2290597 CLIA NUMBER - SHIMA HADIDCHI M.D A PROFESSIONAL CORP DBA FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 05D2290597
  • Facility Name: SHIMA HADIDCHI M.D A PROFESSIONAL CORP DBA FAMILY PRACTICE
  • Facility Address: 18112 US HIGHWAY 18 SUITE 102
    APPLE VALLEY, CA
    ZIP 92307
  • Facility Phone: 760 998-1999
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHIMA HADIDCHI
  • NPI Number: 1780975839
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2290597
LAB Type Physician Office
Facility Name SHIMA HADIDCHI M.D A PROFESSIONAL CORP DBA FAMILY PRACTICE
Street 18112 US HIGHWAY 18 SUITE 102
City APPLE VALLEY
State CA
ZIP 92307
Phone 760 998-1999
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2025
Certificate Expiration Date 9/26/2027
Facility Type Physician Office
Lab Director SHIMA HADIDCHI

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