05D1045230 CLIA NUMBER - THOUSAND OAKS DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 05D1045230
  • Facility Name: THOUSAND OAKS DERMATOLOGY
  • Facility Address: 415 E ROLLING OAKS DR STE 110
    THOUSAND OAKS, CA
    ZIP 91361
  • Facility Phone: 805 557-1740
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: ALEX A. KHADAVI MD
  • NPI Number: 1023159860
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1045230
LAB Type Physician Office
Facility Name THOUSAND OAKS DERMATOLOGY
Street 415 E ROLLING OAKS DR STE 110
City THOUSAND OAKS
State CA
ZIP 91361
Phone 805 557-1740
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 1/19/2022
Certificate Expiration Date 10/31/2025
Facility Type Physician Office
Lab Director ALEX A. KHADAVI MD

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