05D1008631 CLIA NUMBER - SOUTH COAST PEDIATRICS

Laboratory Demographics

  • CLIA Code: 05D1008631
  • Facility Name: SOUTH COAST PEDIATRICS
  • Facility Address: 1720 W BALL RD STE 1
    ANAHEIM, CA
    ZIP 92804
  • Facility Phone: 714 991-5141
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACOB WOLSZTEJN
  • NPI Number: 1891860748
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D1008631
LAB Type Physician Office
Facility Name SOUTH COAST PEDIATRICS
Street 1720 W BALL RD STE 1
City ANAHEIM
State CA
ZIP 92804
Phone 714 991-5141
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2025
Certificate Expiration Date 1/23/2027
Facility Type Physician Office
Lab Director JACOB WOLSZTEJN

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