05D1052088 CLIA NUMBER - MARINA ORTHOPEDIC & SPINE INSTITUTE, LLC

Laboratory Demographics

  • CLIA Code: 05D1052088
  • Facility Name: MARINA ORTHOPEDIC & SPINE INSTITUTE, LLC
  • Facility Address: 13160 MINDANAO WAY STE 150
    MARINA DEL REY, CA
    ZIP 90292
  • Facility Phone: 310 574-0440
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MICHAEL PORT
  • NPI Number: 1740337435
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1052088
LAB Type Ambulatory Surgery Center
Facility Name MARINA ORTHOPEDIC & SPINE INSTITUTE, LLC
Street 13160 MINDANAO WAY STE 150
City MARINA DEL REY
State CA
ZIP 90292
Phone 310 574-0440
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2024
Certificate Expiration Date 3/15/2026
Facility Type Ambulatory Surgery Center
Lab Director MICHAEL PORT

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