05D1018353 CLIA NUMBER - SAN JOSE COMMUNITY CLINIC

Laboratory Demographics

  • CLIA Code: 05D1018353
  • Facility Name: SAN JOSE COMMUNITY CLINIC
  • Facility Address: 11950 INGLEWOOD AVE
    HAWTHORNE, CA
    ZIP 90250
  • Facility Phone: 310 349-8338
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: REZA DANESH MD
  • NPI Number: 1285751024
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1018353
LAB Type Physician Office
Facility Name SAN JOSE COMMUNITY CLINIC
Street 11950 INGLEWOOD AVE
City HAWTHORNE
State CA
ZIP 90250
Phone 310 349-8338
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2025
Certificate Expiration Date 10/19/2027
Facility Type Physician Office
Lab Director REZA DANESH MD

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