05D0897771 CLIA NUMBER - ADEL A BOUTROS, MD

Laboratory Demographics

  • CLIA Code: 05D0897771
  • Facility Name: ADEL A BOUTROS, MD
  • Facility Address: 24432 MUIRLANDS BLVD, STE 101
    LAKE FOREST, CA
    ZIP 92630
  • Facility Phone: 949 951-9399
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ADEL A. BOUTROS, MD
  • NPI Number: 1700952827
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0897771
LAB Type Physician Office
Facility Name ADEL A BOUTROS, MD
Street 24432 MUIRLANDS BLVD, STE 101
City LAKE FOREST
State CA
ZIP 92630
Phone 949 951-9399
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2025
Certificate Expiration Date 2/2/2027
Facility Type Physician Office
Lab Director ADEL A. BOUTROS, MD

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