05D1009428 CLIA NUMBER - LAURIE M WOLL DO DERMATOLOGY A MEDICAL CORPORATION

Laboratory Demographics

  • CLIA Code: 05D1009428
  • Facility Name: LAURIE M WOLL DO DERMATOLOGY A MEDICAL CORPORATION
  • Facility Address: 210 S GRAND AVENUE SUITE407
    GLENDORA, CA
    ZIP 91740
  • Facility Phone: 626 963-0226
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: LAURIE N. WOLL DO
  • NPI Number: 1548076276
  • Taxonomy: 163W00000X - Registered Nurse

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CLIA Record

Field Name Field Value
CLIA Number 05D1009428
LAB Type Physician Office
Facility Name LAURIE M WOLL DO DERMATOLOGY A MEDICAL CORPORATION
Street 210 S GRAND AVENUE SUITE407
City GLENDORA
State CA
ZIP 91740
Phone 626 963-0226
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/13/2025
Certificate Expiration Date 2/12/2027
Facility Type Physician Office
Lab Director LAURIE N. WOLL DO

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