05D0966909 CLIA NUMBER - OCEAN BREEZE MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 05D0966909
  • Facility Name: OCEAN BREEZE MEDICAL GROUP INC
  • Facility Address: 150 AVENIDA CABRILLO #A
    SAN CLEMENTE, CA
    ZIP 92672
  • Facility Phone: 949 369-6993
  • Facility Type: Hospital
  • Facility Type: Microscopy
  • Lab Director: HOTOSA EBRAHIMZADEH MD
  • NPI Number: 1386790400
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0966909
LAB Type Hospital
Facility Name OCEAN BREEZE MEDICAL GROUP INC
Street 150 AVENIDA CABRILLO #A
City SAN CLEMENTE
State CA
ZIP 92672
Phone 949 369-6993
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/27/2023
Certificate Expiration Date 10/26/2025
Facility Type Hospital
Lab Director HOTOSA EBRAHIMZADEH MD

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