05D0891692 CLIA NUMBER - EDWARD R ROYBAL COMPREHENSIVE HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D0891692

Facility Name: EDWARD R ROYBAL COMPREHENSIVE HEALTH CENTER

Facility Address:
245 S FETTERLY AVE RM 2278
LOS ANGELES, CA
ZIP 90022
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Facility Phone Number: 323 362-1403

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1053486944

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	05D0891692
LAB Type	Community Clinic
Facility Name	EDWARD R ROYBAL COMPREHENSIVE HEALTH CENTER
Street	245 S FETTERLY AVE RM 2278
City	LOS ANGELES
State	CA
ZIP	90022
Phone	323 362-1403
CertificateType	3
CertificateEffectiveDate	9/13/2022
CertificateExpirationDate	9/12/2024
FacilityType	PPMP

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