05D0577177 CLIA NUMBER - LALLA-REDDY CORPORATION DBA PACIFIC COAST MEDICAL

Laboratory Demographics

  • CLIA Code: 05D0577177
  • Facility Name: LALLA-REDDY CORPORATION DBA PACIFIC COAST MEDICAL
  • Facility Address: 9940 TALBERT AVE STE 101
    FOUNTAIN VALLEY, CA
    ZIP 92708
  • Facility Phone: 714 968-6789
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUJATA N. LALLA-REDDY MD
  • NPI Number: 1376569277
  • Taxonomy: 207RI0200X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0577177
LAB Type Physician Office
Facility Name LALLA-REDDY CORPORATION DBA PACIFIC COAST MEDICAL
Street 9940 TALBERT AVE STE 101
City FOUNTAIN VALLEY
State CA
ZIP 92708
Phone 714 968-6789
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Physician Office
Lab Director SUJATA N. LALLA-REDDY MD

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This page was last updated on: 6/4/2025