05D0718384 CLIA NUMBER - SAN MARINO MANOR

Laboratory Demographics

  • CLIA Code: 05D0718384
  • Facility Name: SAN MARINO MANOR
  • Facility Address: 6812 N OAK AVENUE
    SAN GABRIEL, CA
    ZIP 91775
  • Facility Phone: 626 446-5263
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: SANTA KERZUMA DO
  • NPI Number: 1750670469
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0718384
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SAN MARINO MANOR
Street 6812 N OAK AVENUE
City SAN GABRIEL
State CA
ZIP 91775
Phone 626 446-5263
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 Skilled Nursing Facility/Nursing Facility
Lab Director SANTA KERZUMA DO

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