05D2291987 CLIA NUMBER - MOUSA MATAR MD INC

Laboratory Demographics

  • CLIA Code: 05D2291987
  • Facility Name: MOUSA MATAR MD INC
  • Facility Address: 4440 BROCKTON AVE UNIT 100
    RIVERSIDE, CA
    ZIP 92501
  • Facility Phone: 951 788-8332
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MOUSA MATAR
  • NPI Number: 1558094904
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2291987
LAB Type Physician Office
Facility Name MOUSA MATAR MD INC
Street 4440 BROCKTON AVE UNIT 100
City RIVERSIDE
State CA
ZIP 92501
Phone 951 788-8332
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2023
Certificate Expiration Date 10/17/2025
Facility Type Physician Office
Lab Director MOUSA MATAR

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