05D0691284 CLIA NUMBER - KEVEN TAGDIRI MD

Laboratory Demographics

  • CLIA Code: 05D0691284
  • Facility Name: KEVEN TAGDIRI MD
  • Facility Address: 4401 MANCHESTER AVE, STE 103
    ENCINITAS, CA
    ZIP 92024
  • Facility Phone: 858 756-3021
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEVEN TAGDIRI
  • NPI Number: 1922000694
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0691284
LAB Type Physician Office
Facility Name KEVEN TAGDIRI MD
Street 4401 MANCHESTER AVE, STE 103
City ENCINITAS
State CA
ZIP 92024
Phone 858 756-3021
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/8/2025
Certificate Expiration Date 3/7/2027
Facility Type Physician Office
Lab Director KEVEN TAGDIRI

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