05D0860421 CLIA NUMBER - LARRY J MARSHALL, MD, APC

Laboratory Demographics

  • CLIA Code: 05D0860421
  • Facility Name: LARRY J MARSHALL, MD, APC
  • Facility Address: 12517 LAKESHORE DR
    LAKESIDE, CA
    ZIP 92040
  • Facility Phone: 619 443-3843
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LARRY J. MARSHALL, MD
  • NPI Number: 1114018132
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0860421
LAB Type Physician Office
Facility Name LARRY J MARSHALL, MD, APC
Street 12517 LAKESHORE DR
City LAKESIDE
State CA
ZIP 92040
Phone 619 443-3843
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2023
Certificate Expiration Date 12/14/2025
Facility Type Physician Office
Lab Director LARRY J. MARSHALL, MD

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