05D0868792 CLIA NUMBER - REZA BONABI MD INC

Laboratory Demographics

  • CLIA Code: 05D0868792
  • Facility Name: REZA BONABI MD INC
  • Facility Address: 17075 DEVONSHIRE STREET SUITE 301
    NORTHRIDGE, CA
    ZIP 91325
  • Facility Phone: 818 368-4212
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GHOLAMREZA NAGADEH BONABI
  • NPI Number: 1366607988
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 05D0868792
LAB Type Physician Office
Facility Name REZA BONABI MD INC
Street 17075 DEVONSHIRE STREET SUITE 301
City NORTHRIDGE
State CA
ZIP 91325
Phone 818 368-4212
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type Physician Office
Lab Director GHOLAMREZA NAGADEH BONABI

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