05D2312129 CLIA NUMBER - MITLA PROFESSIONAL NURSING CARE INC

Laboratory Demographics

  • CLIA Code: 05D2312129
  • Facility Name: MITLA PROFESSIONAL NURSING CARE INC
  • Facility Address: 4111 MAINE AVE
    BALDWIN PARK, CA
    ZIP 91706
  • Facility Phone: 626 939-0676
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EARLA E. QUISIDO
  • NPI Number: 1811750425
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2312129
LAB Type Physician Office
Facility Name MITLA PROFESSIONAL NURSING CARE INC
Street 4111 MAINE AVE
City BALDWIN PARK
State CA
ZIP 91706
Phone 626 939-0676
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2024
Certificate Expiration Date 10/3/2026
Facility Type Physician Office
Lab Director EARLA E. QUISIDO

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