05D0719394 CLIA NUMBER - MARYCREST MANOR

Laboratory Demographics

  • CLIA Code: 05D0719394
  • Facility Name: MARYCREST MANOR
  • Facility Address: 10664 ST JAMES DR
    CULVER CITY, CA
    ZIP 90230
  • Facility Phone: 310 838-2778
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: DR. VINCENT D. NGUYEN
  • NPI Number: 1932193984
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0719394
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MARYCREST MANOR
Street 10664 ST JAMES DR
City CULVER CITY
State CA
ZIP 90230
Phone 310 838-2778
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 DR. VINCENT D. NGUYEN

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