05D1034974 CLIA NUMBER - BRENT J MICHAEL, MD INC

Laboratory Demographics

  • CLIA Code: 05D1034974
  • Facility Name: BRENT J MICHAEL, MD INC
  • Facility Address: 2001 SANTA MONICA BLVD, STE 470W
    SANTA MONICA, CA
    ZIP 90404
  • Facility Phone: 310 829-7777
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRENT J. MICHAEL
  • NPI Number: 1275698052
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1034974
LAB Type Physician Office
Facility Name BRENT J MICHAEL, MD INC
Street 2001 SANTA MONICA BLVD, STE 470W
City SANTA MONICA
State CA
ZIP 90404
Phone 310 829-7777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Physician Office
Lab Director BRENT J. MICHAEL

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