05D0911780 CLIA NUMBER - UCSD PERLMANKOMAN OUTPATIENT PAVILION

Laboratory Demographics

  • CLIA Code: 05D0911780
  • Facility Name: UCSD PERLMANKOMAN OUTPATIENT PAVILION
  • Facility Address: 9350 CAMPUS POINT DR, MC 0976
    LA JOLLA, CA
    ZIP 92037
  • Facility Phone: 858 657-8612
  • Facility Type: Other - AMBULATORY CARE CENTER
  • Facility Type: Waiver
  • Lab Director: ANDREW A. KADER MD
  • NPI Number: 1619079464
  • Taxonomy: 273R00000X - Psychiatric Unit

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CLIA Record

Field Name Field Value
CLIA Number 05D0911780
LAB Type Other - AMBULATORY CARE CENTER
Facility Name UCSD PERLMANKOMAN OUTPATIENT PAVILION
Street 9350 CAMPUS POINT DR, MC 0976
City LA JOLLA
State CA
ZIP 92037
Phone 858 657-8612
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2023
Certificate Expiration Date 11/15/2025
Facility Type Other - AMBULATORY CARE CENTER
Lab Director ANDREW A. KADER MD

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