05D0970132 CLIA NUMBER - JACK M GINDI MD

Laboratory Demographics

  • CLIA Code: 05D0970132
  • Facility Name: JACK M GINDI MD
  • Facility Address: 29525 CANWOOD ST STE 209
    AGOURA HILLS, CA
    ZIP 91301
  • Facility Phone: 818 706-7773
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACK M. GINDI MD
  • NPI Number: 1518048255
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0970132
LAB Type Physician Office
Facility Name JACK M GINDI MD
Street 29525 CANWOOD ST STE 209
City AGOURA HILLS
State CA
ZIP 91301
Phone 818 706-7773
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2024
Certificate Expiration Date 2/3/2026
Facility Type Physician Office
Lab Director JACK M. GINDI MD

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