05D1045744 CLIA NUMBER - VENICE FAMILY CLINIC - COLEN FAMILY HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D1045744

Facility Name: VENICE FAMILY CLINIC - COLEN FAMILY HEALTH CENTER

Facility Address:
4700 INGLEWOOD BLVD STE 102
CULVER CITY, CA
ZIP 90230
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Facility Phone Number: 310 664-7667

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1467127951

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1045744
LAB Type	Federally Qualified Health Center
Facility Name	VENICE FAMILY CLINIC - COLEN FAMILY HEALTH CENTER
Street	4700 INGLEWOOD BLVD STE 102
City	CULVER CITY
State	CA
ZIP	90230
Phone	310 664-7667
CertificateType	4
CertificateEffectiveDate	9/21/2023
CertificateExpirationDate	9/20/2025
FacilityType	Waiver

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