05D0861114 CLIA NUMBER - WEST BEVERLY PODIATRY GROUP

Laboratory Demographics

  • CLIA Code: 05D0861114
  • Facility Name: WEST BEVERLY PODIATRY GROUP
  • Facility Address: 1417 W BEVERLY BLVD STE 104
    MONTEBELLO, CA
    ZIP 90640
  • Facility Phone: 323 721-6026
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL R. VEGA DPM
  • NPI Number: 1003023458
  • Taxonomy: 213E00000X - Podiatrist

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CLIA Record

Field Name Field Value
CLIA Number 05D0861114
LAB Type Physician Office
Facility Name WEST BEVERLY PODIATRY GROUP
Street 1417 W BEVERLY BLVD STE 104
City MONTEBELLO
State CA
ZIP 90640
Phone 323 721-6026
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2025
Certificate Expiration Date 3/17/2027
Facility Type Physician Office
Lab Director MICHAEL R. VEGA DPM

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This page was last updated on: 6/4/2025