05D0553407 CLIA NUMBER - PATIENT PREFERRED DERMATOLOGY MEDICAL GROUP INC

Laboratory Demographics

CLIA Number: 05D0553407

Facility Name: PATIENT PREFERRED DERMATOLOGY MEDICAL GROUP INC

Facility Address:
3772 KATELLA AVE STE 206
LOS ALAMITOS, CA
ZIP 90720
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Facility Phone Number: 562 430-4294

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1851459234

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D0553407
LAB Type	Physician Office
Facility Name	PATIENT PREFERRED DERMATOLOGY MEDICAL GROUP INC
Street	3772 KATELLA AVE STE 206
City	LOS ALAMITOS
State	CA
ZIP	90720
Phone	562 430-4294
CertificateType	2
CertificateEffectiveDate	8/28/2021
CertificateExpirationDate	4/30/2024
FacilityType	Compliance

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