05D2294635 CLIA NUMBER - TRIDENT MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 05D2294635
  • Facility Name: TRIDENT MEDICAL CENTER
  • Facility Address: 18564 US HIGHWAY 18 STE 104
    APPLE VALLEY, CA
    ZIP 92307
  • Facility Phone: 484 557-9511
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NYRA KHETARPAL
  • NPI Number: 1093498230
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2294635
LAB Type Physician Office
Facility Name TRIDENT MEDICAL CENTER
Street 18564 US HIGHWAY 18 STE 104
City APPLE VALLEY
State CA
ZIP 92307
Phone 484 557-9511
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2023
Certificate Expiration Date 11/27/2025
Facility Type Physician Office
Lab Director NYRA KHETARPAL

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