05D0907670 CLIA NUMBER - MOHAN P KUMARATNE, MD

Laboratory Demographics

CLIA Number: 05D0907670

Facility Name: MOHAN P KUMARATNE, MD

Facility Address:
17692 BEACH BLVD, STE 200
HUNTINGTON BEACH, CA
ZIP 92647
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Facility Phone Number: 714 847-6975

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1104881523

Taxonomy: 2080A0000X - Pediatrics
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

CLIA Record

Field Name	Field Value
CLIA Number	05D0907670
LAB Type	Physician Office
Facility Name	MOHAN P KUMARATNE, MD
Street	17692 BEACH BLVD, STE 200
City	HUNTINGTON BEACH
State	CA
ZIP	92647
Phone	714 847-6975
CertificateType	4
CertificateEffectiveDate	10/18/2023
CertificateExpirationDate	10/17/2025
FacilityType	Waiver

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