05D0705927 CLIA NUMBER - PACIFIC NEPHROLOGY MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D0705927
  • Facility Name: PACIFIC NEPHROLOGY MEDICAL GROUP
  • Facility Address: 323 N PRAIRIE AVE #334
    INGLEWOOD, CA
    ZIP 90301
  • Facility Phone: 310 674-8600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD L. SIRES
  • NPI Number: 1922013515
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0705927
LAB Type Physician Office
Facility Name PACIFIC NEPHROLOGY MEDICAL GROUP
Street 323 N PRAIRIE AVE #334
City INGLEWOOD
State CA
ZIP 90301
Phone 310 674-8600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director RICHARD L. SIRES

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