05D0560868 CLIA NUMBER - PEDIATRIC ASSOCIATES MEDICAL GROUP INC

Laboratory Demographics

CLIA Number: 05D0560868

Facility Name: PEDIATRIC ASSOCIATES MEDICAL GROUP INC

Facility Address:
4330 FULTON AVE
SHERMAN OAKS, CA
ZIP 91423
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Facility Phone Number: 818 784-1102

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1255366712

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0560868
LAB Type	Physician Office
Facility Name	PEDIATRIC ASSOCIATES MEDICAL GROUP INC
Street	4330 FULTON AVE
City	SHERMAN OAKS
State	CA
ZIP	91423
Phone	818 784-1102
CertificateType	3
CertificateEffectiveDate	11/12/2023
CertificateExpirationDate	11/11/2025
FacilityType	PPMP

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