05D0697349 CLIA NUMBER - PRESTIGE CARE PHYSICIAN, INC

Laboratory Demographics

  • CLIA Code: 05D0697349
  • Facility Name: PRESTIGE CARE PHYSICIAN, INC
  • Facility Address: 23600 TELO AVENUE, SUITE 145
    TORRANCE, CA
    ZIP 90505
  • Facility Phone: 310 325-8514
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HICHAM SIOUTY MD
  • NPI Number: 1215255583
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0697349
LAB Type Physician Office
Facility Name PRESTIGE CARE PHYSICIAN, INC
Street 23600 TELO AVENUE, SUITE 145
City TORRANCE
State CA
ZIP 90505
Phone 310 325-8514
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/22/2025
Certificate Expiration Date 1/21/2027
Facility Type Physician Office
Lab Director HICHAM SIOUTY MD

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