05D0865508 CLIA NUMBER - HOLLYWOOD CROSS MEDICAL CLINIC, INC

Laboratory Demographics

CLIA Number: 05D0865508

Facility Name: HOLLYWOOD CROSS MEDICAL CLINIC, INC

Facility Address:
1110 N WESTERN AVE, SUITE 201
LOS ANGELES, CA
ZIP 90029
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Facility Phone Number: 323 463-6881

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1649209743

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0865508
LAB Type	Physician Office
Facility Name	HOLLYWOOD CROSS MEDICAL CLINIC, INC
Street	1110 N WESTERN AVE, SUITE 201
City	LOS ANGELES
State	CA
ZIP	90029
Phone	323 463-6881
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024