05D2291996 CLIA NUMBER - EAGLE ROCK MEDICAL CENTER

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Laboratory Demographics

CLIA Number: 05D2291996

Facility Name: EAGLE ROCK MEDICAL CENTER

Facility Address:
4867 EAGLE ROCK BLVD SUITE 1
LOS ANGELES, CA
ZIP 90041
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Facility Phone Number: 818 395-2248

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932381266

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	05D2291996
LAB Type	Physician Office
Facility Name	EAGLE ROCK MEDICAL CENTER
Street	4867 EAGLE ROCK BLVD SUITE 1
City	LOS ANGELES
State	CA
ZIP	90041
Phone	818 395-2248
CertificateType	4
CertificateEffectiveDate	10/18/2023
CertificateExpirationDate	10/17/2025
FacilityType	Waiver

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