05D0931714 CLIA NUMBER - ADVENTIST HEALTH / WHITE MEMORIAL MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D0931714

Facility Name: ADVENTIST HEALTH / WHITE MEMORIAL MEDICAL GROUP

Facility Address:
1701 E CESAR CHAVEZ AVENUE STE 510
LOS ANGELES, CA
ZIP 90033
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Facility Phone Number: 323 987-1362

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1063892867

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	05D0931714
LAB Type	Physician Office
Facility Name	ADVENTIST HEALTH / WHITE MEMORIAL MEDICAL GROUP
Street	1701 E CESAR CHAVEZ AVENUE STE 510
City	LOS ANGELES
State	CA
ZIP	90033
Phone	323 987-1362
CertificateType	4
CertificateEffectiveDate	8/4/2023
CertificateExpirationDate	8/3/2025
FacilityType	Waiver

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