05D1004698 CLIA NUMBER - REPHANA MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 05D1004698
  • Facility Name: REPHANA MEDICAL GROUP INC
  • Facility Address: 1304 15TH STREET, SUITE 402
    SANTA MONICA, CA
    ZIP 90404
  • Facility Phone: 310 451-5684
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NEAL SHANBLATT MD
  • NPI Number: 1659414258
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1004698
LAB Type Physician Office
Facility Name REPHANA MEDICAL GROUP INC
Street 1304 15TH STREET, SUITE 402
City SANTA MONICA
State CA
ZIP 90404
Phone 310 451-5684
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2024
Certificate Expiration Date 10/2/2026
Facility Type Physician Office
Lab Director NEAL SHANBLATT MD

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