05D2292078 CLIA NUMBER - SCOTT RUSSELL DO MHA

Laboratory Demographics

  • CLIA Code: 05D2292078
  • Facility Name: SCOTT RUSSELL DO MHA
  • Facility Address: 41120 WASHINGTON ST, SUITE 210
    INDIO, CA
    ZIP 92203
  • Facility Phone: 760 391-8436
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SCOTT A. RUSSELL
  • NPI Number: 1144919911
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2292078
LAB Type Physician Office
Facility Name SCOTT RUSSELL DO MHA
Street 41120 WASHINGTON ST, SUITE 210
City INDIO
State CA
ZIP 92203
Phone 760 391-8436
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2025
Certificate Expiration Date 10/18/2027
Facility Type Physician Office
Lab Director SCOTT A. RUSSELL

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