05D0553665 CLIA NUMBER - SIAMAK STEPHEN MARZBAN, MD INC

Laboratory Demographics

CLIA Number: 05D0553665

Facility Name: SIAMAK STEPHEN MARZBAN, MD INC

Facility Address:
2403 MORAY AVE STE 2A
SAN PEDRO, CA
ZIP 90732
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Facility Phone Number: 310 832-2694

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1699076885

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	05D0553665
LAB Type	Physician Office
Facility Name	SIAMAK STEPHEN MARZBAN, MD INC
Street	2403 MORAY AVE STE 2A
City	SAN PEDRO
State	CA
ZIP	90732
Phone	310 832-2694
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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