05D1029386 CLIA NUMBER - ADVANCED DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 05D1029386
  • Facility Name: ADVANCED DERMATOLOGY
  • Facility Address: 210 S GRAND AVE, STE 208
    GLENDORA, CA
    ZIP 91741
  • Facility Phone: 626 914-3675
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: LEILA ETTEFAGH, MD
  • NPI Number: 1063903425
  • Taxonomy: 101YM0800X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 05D1029386
LAB Type Physician Office
Facility Name ADVANCED DERMATOLOGY
Street 210 S GRAND AVE, STE 208
City GLENDORA
State CA
ZIP 91741
Phone 626 914-3675
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/22/2023
Certificate Expiration Date 10/31/2025
Facility Type Physician Office
Lab Director LEILA ETTEFAGH, MD

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