12D2165082 CLIA NUMBER - GLORIA EDEN G DOMINGO, MD LLC

Laboratory Demographics

CLIA Number: 12D2165082

Facility Name: GLORIA EDEN G DOMINGO, MD LLC

Facility Address:
94-333 WAIPAHU DEPOT ST #M6
WAIPAHU, HI
ZIP 96797
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Facility Phone Number: 808 677-5664

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1205130655

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	12D2165082
LAB Type	Physician Office
Facility Name	GLORIA EDEN G DOMINGO, MD LLC
Street	94-333 WAIPAHU DEPOT ST #M6
City	WAIPAHU
State	HI
ZIP	96797
Phone	808 677-5664
CertificateType	4
CertificateEffectiveDate	4/18/2023
CertificateExpirationDate	4/17/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024