05D0713845 CLIA NUMBER - BRENTVIEW MEDICAL

Laboratory Demographics

  • CLIA Code: 05D0713845
  • Facility Name: BRENTVIEW MEDICAL
  • Facility Address: 11611 SAN VICENTE BLVD
    LOS ANGELES, CA
    ZIP 90049
  • Facility Phone: 310 820-0013
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAPHAEL DARVISH
  • NPI Number: 1326631177
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0713845
LAB Type Physician Office
Facility Name BRENTVIEW MEDICAL
Street 11611 SAN VICENTE BLVD
City LOS ANGELES
State CA
ZIP 90049
Phone 310 820-0013
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/20/2024
Certificate Expiration Date 8/19/2026
Facility Type Physician Office
Lab Director RAPHAEL DARVISH

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