05D0880808 CLIA NUMBER - SOMA MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D0880808
  • Facility Name: SOMA MEDICAL GROUP
  • Facility Address: 1959 KINGSDALE AVE
    REDONDO BEACH, CA
    ZIP 90278
  • Facility Phone: 310 214-1000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SOHAIL M. DAVOUDIAN
  • NPI Number: 1063434900
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0880808
LAB Type Physician Office
Facility Name SOMA MEDICAL GROUP
Street 1959 KINGSDALE AVE
City REDONDO BEACH
State CA
ZIP 90278
Phone 310 214-1000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Physician Office
Lab Director SOHAIL M. DAVOUDIAN

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