05D1012624 CLIA NUMBER - LIGHT BRIDGE HOSPICE

Laboratory Demographics

  • CLIA Code: 05D1012624
  • Facility Name: LIGHT BRIDGE HOSPICE
  • Facility Address: 6155 CORNERSTONE CT EAST STE 220
    SAN DIEGO, CA
    ZIP 92121
  • Facility Phone: 858 458-2992
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: EMMET W. LEE
  • NPI Number: 1689901068
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 05D1012624
LAB Type Hospice
Facility Name LIGHT BRIDGE HOSPICE
Street 6155 CORNERSTONE CT EAST STE 220
City SAN DIEGO
State CA
ZIP 92121
Phone 858 458-2992
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2025
Certificate Expiration Date 5/14/2027
Facility Type Hospice
Lab Director EMMET W. LEE

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