05D0545801 CLIA NUMBER - BRUCE GILLIS MD MPH

Laboratory Demographics

  • CLIA Code: 05D0545801
  • Facility Name: BRUCE GILLIS MD MPH
  • Facility Address: 11801 W OLYMPIC BLVD
    LOS ANGELES, CA
    ZIP 90064
  • Facility Phone: 310 268-1010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRUCE S. GILLIS
  • NPI Number: 1013945542
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0545801
LAB Type Physician Office
Facility Name BRUCE GILLIS MD MPH
Street 11801 W OLYMPIC BLVD
City LOS ANGELES
State CA
ZIP 90064
Phone 310 268-1010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/20/2024
Certificate Expiration Date 2/19/2026
Facility Type Physician Office
Lab Director BRUCE S. GILLIS

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