05D0964810 CLIA NUMBER - EASTSIDE FAMILY MEDICAL ASSOCIATES, INC

Laboratory Demographics

CLIA Number: 05D0964810

Facility Name: EASTSIDE FAMILY MEDICAL ASSOCIATES, INC

Facility Address:
321 S MEDNIK AVE
LOS ANGELES, CA
ZIP 90022
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Facility Phone Number: 323 261-4706

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1568656791

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0964810
LAB Type	Physician Office
Facility Name	EASTSIDE FAMILY MEDICAL ASSOCIATES, INC
Street	321 S MEDNIK AVE
City	LOS ANGELES
State	CA
ZIP	90022
Phone	323 261-4706
CertificateType	4
CertificateEffectiveDate	9/3/2023
CertificateExpirationDate	9/2/2025
FacilityType	Waiver

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