05D0685858 CLIA NUMBER - WILLIAM J WICKWIRE MD INC

Laboratory Demographics

  • CLIA Code: 05D0685858
  • Facility Name: WILLIAM J WICKWIRE MD INC
  • Facility Address: 500 PACIFIC COAST HWY, STE 212
    SEAL BEACH, CA
    ZIP 90740
  • Facility Phone: 562 431-8554
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: GEOVER FERNANDEZ
  • NPI Number: 1881659142
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0685858
LAB Type Physician Office
Facility Name WILLIAM J WICKWIRE MD INC
Street 500 PACIFIC COAST HWY, STE 212
City SEAL BEACH
State CA
ZIP 90740
Phone 562 431-8554
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 2/21/2025
Certificate Expiration Date 2/20/2027
Facility Type Physician Office
Lab Director GEOVER FERNANDEZ

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