05D0547251 CLIA NUMBER - PROSTATE ONCOLOGY SPECIALIST, INC

Laboratory Demographics

  • CLIA Code: 05D0547251
  • Facility Name: PROSTATE ONCOLOGY SPECIALIST, INC
  • Facility Address: 4650 ADMIRALTY WAY, STE 111
    MARINA DEL REY, CA
    ZIP 90292
  • Facility Phone: 310 827-7707
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. MARK C. SCHOLZ MD
  • NPI Number: 1588653943
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 05D0547251
LAB Type Physician Office
Facility Name PROSTATE ONCOLOGY SPECIALIST, INC
Street 4650 ADMIRALTY WAY, STE 111
City MARINA DEL REY
State CA
ZIP 90292
Phone 310 827-7707
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 8/3/2024
Certificate Expiration Date 8/2/2026
Facility Type Physician Office
Lab Director DR. MARK C. SCHOLZ MD

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