05D0701542 CLIA NUMBER - DOUGLAS TYLER, MD A PROF MED CORPORATION

Laboratory Demographics

  • CLIA Code: 05D0701542
  • Facility Name: DOUGLAS TYLER, MD A PROF MED CORPORATION
  • Facility Address: 2811 WILSHIRE BLVD, SUITE 800
    SANTA MONICA, CA
    ZIP 90403
  • Facility Phone: 310 828-0733
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: DOUGLAS TYLER
  • NPI Number: 1447357249
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0701542
LAB Type Hospice
Facility Name DOUGLAS TYLER, MD A PROF MED CORPORATION
Street 2811 WILSHIRE BLVD, SUITE 800
City SANTA MONICA
State CA
ZIP 90403
Phone 310 828-0733
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2025
Certificate Expiration Date 6/27/2027
Facility Type Hospice
Lab Director DOUGLAS TYLER

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