05D2292570 CLIA NUMBER - 417 NORTH COUNTY LLC DBA 417 RECOVERY

Laboratory Demographics

  • CLIA Code: 05D2292570
  • Facility Name: 417 NORTH COUNTY LLC DBA 417 RECOVERY
  • Facility Address: 1595 GRAND AVE STE 102
    SAN MARCOS, CA
    ZIP 92078
  • Facility Phone: 760 566-7995
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: ALEJANDRO ALVA
  • NPI Number: 1356915821
  • Taxonomy: 3245S0500X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2292570
LAB Type Ancillary Testing Site in Health Care Center
Facility Name 417 NORTH COUNTY LLC DBA 417 RECOVERY
Street 1595 GRAND AVE STE 102
City SAN MARCOS
State CA
ZIP 92078
Phone 760 566-7995
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Ancillary Testing Site in Health Care Center
Lab Director ALEJANDRO ALVA

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