05D2329689 CLIA NUMBER - PROVIDENCE MAIN STREET UCC

Laboratory Demographics

  • CLIA Code: 05D2329689
  • Facility Name: PROVIDENCE MAIN STREET UCC
  • Facility Address: 363 S MAIN ST, SUITE 110
    ORANGE, CA
    ZIP 92868
  • Facility Phone: 714 855-3602
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRISTIAN LISING
  • NPI Number: 1861180671
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2329689
LAB Type Physician Office
Facility Name PROVIDENCE MAIN STREET UCC
Street 363 S MAIN ST, SUITE 110
City ORANGE
State CA
ZIP 92868
Phone 714 855-3602
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2025
Certificate Expiration Date 9/3/2027
Facility Type Physician Office
Lab Director CHRISTIAN LISING

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