05D1051260 CLIA NUMBER - ST JOHN MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 05D1051260
  • Facility Name: ST JOHN MEDICAL GROUP INC
  • Facility Address: 3530 LONG BEACH BLVD STE 120
    LONG BEACH, CA
    ZIP 90807
  • Facility Phone: 562 989-1200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: YOUSSEF B. AWAD
  • NPI Number: 1013188721
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1051260
LAB Type Physician Office
Facility Name ST JOHN MEDICAL GROUP INC
Street 3530 LONG BEACH BLVD STE 120
City LONG BEACH
State CA
ZIP 90807
Phone 562 989-1200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2024
Certificate Expiration Date 2/26/2026
Facility Type Physician Office
Lab Director YOUSSEF B. AWAD

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