05D0983617 CLIA NUMBER - VICTOR M WASSILY MD

Laboratory Demographics

  • CLIA Code: 05D0983617
  • Facility Name: VICTOR M WASSILY MD
  • Facility Address: 101 EAST BEVERLY BLVD SUITE 202
    MONTEBELLO, CA
    ZIP 90640
  • Facility Phone: 323 722-7711
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VICTOR M. WASSILY
  • NPI Number: 1962423590
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0983617
LAB Type Physician Office
Facility Name VICTOR M WASSILY MD
Street 101 EAST BEVERLY BLVD SUITE 202
City MONTEBELLO
State CA
ZIP 90640
Phone 323 722-7711
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2024
Certificate Expiration Date 8/20/2026
Facility Type Physician Office
Lab Director VICTOR M. WASSILY

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