05D0901439 CLIA NUMBER - EDWARD G SHORE, MD

Laboratory Demographics

  • CLIA Code: 05D0901439
  • Facility Name: EDWARD G SHORE, MD
  • Facility Address: 15243 VANOWEN STREET SUITE 412
    VAN NUYS, CA
    ZIP 91405
  • Facility Phone: 818 783-4800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD G. SHORE
  • NPI Number: 1699846709
  • Taxonomy: 207QA0505X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D0901439
LAB Type Physician Office
Facility Name EDWARD G SHORE, MD
Street 15243 VANOWEN STREET SUITE 412
City VAN NUYS
State CA
ZIP 91405
Phone 818 783-4800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2025
Certificate Expiration Date 5/23/2027
Facility Type Physician Office
Lab Director EDWARD G. SHORE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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