05D0580056 CLIA NUMBER - CHARLES JACKSON MD

Laboratory Demographics

  • CLIA Code: 05D0580056
  • Facility Name: CHARLES JACKSON MD
  • Facility Address: 17122 BEACH BLVD, SUITE 102
    HUNTINGTON BEACH, CA
    ZIP 92647
  • Facility Phone: 714 847-6545
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHARLES W. JACKSON
  • NPI Number: 1083662845
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 05D0580056
LAB Type Physician Office
Facility Name CHARLES JACKSON MD
Street 17122 BEACH BLVD, SUITE 102
City HUNTINGTON BEACH
State CA
ZIP 92647
Phone 714 847-6545
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/31/2024
Certificate Expiration Date 8/30/2026
Facility Type Physician Office
Lab Director CHARLES W. JACKSON

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