05D0559177 CLIA NUMBER - COASTAL KIDS, A PROFESSIONAL MED CORP PEDIATRIC MEDICAL GROUP OF SO CALIFORNIA, THE

Laboratory Demographics

  • CLIA Code: 05D0559177
  • Facility Name: COASTAL KIDS, A PROFESSIONAL MED CORP PEDIATRIC MEDICAL GROUP OF SO CALIFORNIA, THE
  • Facility Address: 18370 BURBANK BLVD, STE 307
    TARZANA, CA
    ZIP 91356
  • Facility Phone: 714 842-0444
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. BRIAN K. GREENBERG
  • NPI Number: 1417094418
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D0559177
LAB Type Physician Office
Facility Name COASTAL KIDS, A PROFESSIONAL MED CORP PEDIATRIC MEDICAL GROUP OF SO CALIFORNIA, THE
Street 18370 BURBANK BLVD, STE 307
City TARZANA
State CA
ZIP 91356
Phone 714 842-0444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director DR. BRIAN K. GREENBERG

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