05D0937821 CLIA NUMBER - LA COMMUNITY CARE MEDICAL ASSOCIATES INC

Laboratory Demographics

  • CLIA Code: 05D0937821
  • Facility Name: LA COMMUNITY CARE MEDICAL ASSOCIATES INC
  • Facility Address: 11633 HAWTHORNE BLVD, #103
    HAWTHORNE, CA
    ZIP 90250
  • Facility Phone: 310 219-2929
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AUGUSTINE E. ILUORE
  • NPI Number: 1801099486
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0937821
LAB Type Physician Office
Facility Name LA COMMUNITY CARE MEDICAL ASSOCIATES INC
Street 11633 HAWTHORNE BLVD, #103
City HAWTHORNE
State CA
ZIP 90250
Phone 310 219-2929
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2025
Certificate Expiration Date 6/2/2027
Facility Type Physician Office
Lab Director AUGUSTINE E. ILUORE

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