05D0906600 CLIA NUMBER - JASON BOUTROS, MD INC

Laboratory Demographics

  • CLIA Code: 05D0906600
  • Facility Name: JASON BOUTROS, MD INC
  • Facility Address: 2554 E WASHINGTON BLVD STE A
    PASADENA, CA
    ZIP 91107
  • Facility Phone: 626 798-8923
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JASON BOUTROS
  • NPI Number: 1942243563
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 05D0906600
LAB Type Physician Office
Facility Name JASON BOUTROS, MD INC
Street 2554 E WASHINGTON BLVD STE A
City PASADENA
State CA
ZIP 91107
Phone 626 798-8923
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2025
Certificate Expiration Date 10/2/2027
Facility Type Physician Office
Lab Director JASON BOUTROS

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