05D1032204 CLIA NUMBER - ADVANCED DERMATOLOGY CARE OF S C

Laboratory Demographics

CLIA Number: 05D1032204

Facility Name: ADVANCED DERMATOLOGY CARE OF S C

Facility Address:
3851 KATELLA AVE STE 105
LOS ALAMITOS, CA
ZIP 90720
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Facility Phone Number: 310 738-6006

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1205286713

Taxonomy: 261QS1200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1032204
LAB Type	Physician Office
Facility Name	ADVANCED DERMATOLOGY CARE OF S C
Street	3851 KATELLA AVE STE 105
City	LOS ALAMITOS
State	CA
ZIP	90720
Phone	310 738-6006
CertificateType	2
CertificateEffectiveDate	9/1/2021
CertificateExpirationDate	4/30/2024
FacilityType	Compliance

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This page was last updated on: 4/23/2024