05D0946350 CLIA NUMBER - MAR VISTA COUNTRY VILLA HEALTHCARE & WELLNESS CENTER, LP

Laboratory Demographics

  • CLIA Code: 05D0946350
  • Facility Name: MAR VISTA COUNTRY VILLA HEALTHCARE & WELLNESS CENTER, LP
  • Facility Address: 3966 MARCASEL AVENUE
    LOS ANGELES, CA
    ZIP 90066
  • Facility Phone: 310 397-2372
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: PAYMON BANAFSHE MD
  • NPI Number: 1972878718
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D0946350
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name MAR VISTA COUNTRY VILLA HEALTHCARE & WELLNESS CENTER, LP
Street 3966 MARCASEL AVENUE
City LOS ANGELES
State CA
ZIP 90066
Phone 310 397-2372
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2024
Certificate Expiration Date 5/21/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director PAYMON BANAFSHE MD

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