05D1053414 CLIA NUMBER - UNIQUE MEDI TECH LLC DBA MAMMOTH DX

Laboratory Demographics

  • CLIA Code: 05D1053414
  • Facility Name: UNIQUE MEDI TECH LLC DBA MAMMOTH DX
  • Facility Address: 20523 CRESCENT BAY DR
    LAKE FOREST, CA
    ZIP 92630
  • Facility Phone: 562 200-5054
  • Facility Type: Independent
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. ANDREW BURG
  • NPI Number: 1417099383
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 05D1053414
LAB Type Independent
Facility Name UNIQUE MEDI TECH LLC DBA MAMMOTH DX
Street 20523 CRESCENT BAY DR
City LAKE FOREST
State CA
ZIP 92630
Phone 562 200-5054
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 5/23/2024
Certificate Expiration Date 5/22/2026
Facility Type Independent
Lab Director DR. ANDREW BURG

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