05D0952704 CLIA NUMBER - CADUCEUS PHYSICIANS MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D0952704
  • Facility Name: CADUCEUS PHYSICIANS MEDICAL GROUP
  • Facility Address: 333 THALIA ST
    LAGUNA BEACH, CA
    ZIP 92651
  • Facility Phone: 949 499-0577
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GREGG A. DE NICOLA
  • NPI Number: 1841404142
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0952704
LAB Type Physician Office
Facility Name CADUCEUS PHYSICIANS MEDICAL GROUP
Street 333 THALIA ST
City LAGUNA BEACH
State CA
ZIP 92651
Phone 949 499-0577
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Physician Office
Lab Director GREGG A. DE NICOLA

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