05D2306910 CLIA NUMBER - HUMBLED ONE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2306910
  • Facility Name: HUMBLED ONE MEDICAL GROUP
  • Facility Address: 5471 LA PALMA AVE STE 105
    LA PALMA, CA
    ZIP 90623
  • Facility Phone: 714 695-2388
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DIPANKAR GHOSH
  • NPI Number: 1073360467
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 05D2306910
LAB Type Physician Office
Facility Name HUMBLED ONE MEDICAL GROUP
Street 5471 LA PALMA AVE STE 105
City LA PALMA
State CA
ZIP 90623
Phone 714 695-2388
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/26/2024
Certificate Expiration Date 6/25/2026
Facility Type Physician Office
Lab Director DIPANKAR GHOSH

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