05D1042925 CLIA NUMBER - ESHAGH EZRA MD INC

Laboratory Demographics

  • CLIA Code: 05D1042925
  • Facility Name: ESHAGH EZRA MD INC
  • Facility Address: 18433 ROSCOE BLVD, STE 202
    NORTHRIDGE, CA
    ZIP 91325
  • Facility Phone: 818 891-5500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ESHAGH EZRA
  • NPI Number: 1790797835
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D1042925
LAB Type Physician Office
Facility Name ESHAGH EZRA MD INC
Street 18433 ROSCOE BLVD, STE 202
City NORTHRIDGE
State CA
ZIP 91325
Phone 818 891-5500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2025
Certificate Expiration Date 7/11/2027
Facility Type Physician Office
Lab Director ESHAGH EZRA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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