05D0907402 CLIA NUMBER - THIRD STREET SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 05D0907402
  • Facility Name: THIRD STREET SURGERY CENTER, LLC
  • Facility Address: 420 E THIRD ST STE 110
    LOS ANGELES, CA
    ZIP 90013
  • Facility Phone: 213 617-9194
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: NICHOLAS MARSICO MD
  • NPI Number: 1144370594
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0907402
LAB Type Ambulatory Surgery Center
Facility Name THIRD STREET SURGERY CENTER, LLC
Street 420 E THIRD ST STE 110
City LOS ANGELES
State CA
ZIP 90013
Phone 213 617-9194
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/13/2023
Certificate Expiration Date 10/12/2025
Facility Type Ambulatory Surgery Center
Lab Director NICHOLAS MARSICO MD

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