05D2296754 CLIA NUMBER - CONG T PHAN

Laboratory Demographics

  • CLIA Code: 05D2296754
  • Facility Name: CONG T PHAN
  • Facility Address: 8235 ROCHESTER AVE STE 110
    RANCHO CUCAMONGA, CA
    ZIP 91730
  • Facility Phone: 909 484-4900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CONG T. PHAN
  • NPI Number: 1386778033
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2296754
LAB Type Physician Office
Facility Name CONG T PHAN
Street 8235 ROCHESTER AVE STE 110
City RANCHO CUCAMONGA
State CA
ZIP 91730
Phone 909 484-4900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Physician Office
Lab Director CONG T. PHAN

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