05D0998782 CLIA NUMBER - LOTUS BLOSSOM THERAPY CENTER

Laboratory Demographics

CLIA Number: 05D0998782

Facility Name: LOTUS BLOSSOM THERAPY CENTER

Facility Address:
1305 W BEVERLY BLVD
MONTEBELLO, CA
ZIP 90640
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Facility Phone Number: 323 346-0360

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1952451064

Taxonomy: 261QA0600X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0998782
LAB Type	Other
Facility Name	LOTUS BLOSSOM THERAPY CENTER
Street	1305 W BEVERLY BLVD
City	MONTEBELLO
State	CA
ZIP	90640
Phone	323 346-0360
CertificateType	4
CertificateEffectiveDate	4/24/2024
CertificateExpirationDate	4/23/2026
FacilityType	Waiver

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