05D2297983 CLIA NUMBER - FONTANA FAMILY AND PEDIATRICS CLINIC

Laboratory Demographics

  • CLIA Code: 05D2297983
  • Facility Name: FONTANA FAMILY AND PEDIATRICS CLINIC
  • Facility Address: 16854 IVY AVENUE
    FONTANA, CA
    ZIP 92335
  • Facility Phone: 909 791-1000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NAMITA P. MOHIDEEN
  • NPI Number: 1942317284
  • Taxonomy: 213ES0103X - Podiatrist

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CLIA Record

Field Name Field Value
CLIA Number 05D2297983
LAB Type Physician Office
Facility Name FONTANA FAMILY AND PEDIATRICS CLINIC
Street 16854 IVY AVENUE
City FONTANA
State CA
ZIP 92335
Phone 909 791-1000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2024
Certificate Expiration Date 1/24/2026
Facility Type Physician Office
Lab Director NAMITA P. MOHIDEEN

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