05D0715851 CLIA NUMBER - MARK BRUCKNER

Laboratory Demographics

  • CLIA Code: 05D0715851
  • Facility Name: MARK BRUCKNER
  • Facility Address: 2876 SYCAMORE DR SUITE 302
    SIMI VALLEY, CA
    ZIP 93065
  • Facility Phone: 805 522-4400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARK N. BRUCKNER
  • NPI Number: 1245226232
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D0715851
LAB Type Physician Office
Facility Name MARK BRUCKNER
Street 2876 SYCAMORE DR SUITE 302
City SIMI VALLEY
State CA
ZIP 93065
Phone 805 522-4400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Physician Office
Lab Director MARK N. BRUCKNER

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