05D0864748 CLIA NUMBER - CENTINELA MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D0864748
  • Facility Name: CENTINELA MEDICAL GROUP
  • Facility Address: 12900 S AVALON BLVD
    LOS ANGELES, CA
    ZIP 90061
  • Facility Phone: 310 538-5222
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANITA W. HIBLER MD
  • NPI Number: 1043654676
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 05D0864748
LAB Type Physician Office
Facility Name CENTINELA MEDICAL GROUP
Street 12900 S AVALON BLVD
City LOS ANGELES
State CA
ZIP 90061
Phone 310 538-5222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2024
Certificate Expiration Date 6/10/2026
Facility Type Physician Office
Lab Director ANITA W. HIBLER MD

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