05D1025391 CLIA NUMBER - EAST LOS ANGELES CARDIOLOGY MED GRP

Laboratory Demographics

  • CLIA Code: 05D1025391
  • Facility Name: EAST LOS ANGELES CARDIOLOGY MED GRP
  • Facility Address: 1701 CESAR CHAVEZ STE 125
    LOS ANGELES, CA
    ZIP 90033
  • Facility Phone: 323 441-1122
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAINIER A. MANZANILLA, MD
  • NPI Number: 1790864213
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1025391
LAB Type Physician Office
Facility Name EAST LOS ANGELES CARDIOLOGY MED GRP
Street 1701 CESAR CHAVEZ STE 125
City LOS ANGELES
State CA
ZIP 90033
Phone 323 441-1122
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2024
Certificate Expiration Date 5/4/2026
Facility Type Physician Office
Lab Director RAINIER A. MANZANILLA, MD

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This page was last updated on: 3/20/2025