05D0990695 CLIA NUMBER - ALTA MED PACE GRAND PLAZA

Laboratory Demographics

  • CLIA Code: 05D0990695
  • Facility Name: ALTA MED PACE GRAND PLAZA
  • Facility Address: 701 W CESAR CHAVEZ AVE STE 201
    LOS ANGELES, CA
    ZIP 90012
  • Facility Phone: 213 217-5300
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: ESIQUIO G. CASILLAS MD
  • NPI Number: 1871030718
  • Taxonomy: 207RG0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0990695
LAB Type Federally Qualified Health Center
Facility Name ALTA MED PACE GRAND PLAZA
Street 701 W CESAR CHAVEZ AVE STE 201
City LOS ANGELES
State CA
ZIP 90012
Phone 213 217-5300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/29/2025
Certificate Expiration Date 8/28/2027
Facility Type Federally Qualified Health Center
Lab Director ESIQUIO G. CASILLAS MD

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