05D0679210 CLIA NUMBER - CHLAMG / PATHOLOGY LP ADOLESCENT MEDICINE

Laboratory Demographics

  • CLIA Code: 05D0679210
  • Facility Name: CHLAMG / PATHOLOGY LP ADOLESCENT MEDICINE
  • Facility Address: 3250 WILSHIRE BLVD, 3RD FLOOR
    LOS ANGELES, CA
    ZIP 90010
  • Facility Phone: 323 361-4958
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. ALEXANDER R. JUDKINS
  • NPI Number: 1316241102
  • Taxonomy: 207ZP0102X - Pathology

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CLIA Record

Field Name Field Value
CLIA Number 05D0679210
LAB Type Physician Office
Facility Name CHLAMG / PATHOLOGY LP ADOLESCENT MEDICINE
Street 3250 WILSHIRE BLVD, 3RD FLOOR
City LOS ANGELES
State CA
ZIP 90010
Phone 323 361-4958
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director DR. ALEXANDER R. JUDKINS

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