05D1071199 CLIA NUMBER - SCPMG ALTON SAND CANYON MOB 2

Laboratory Demographics

  • CLIA Code: 05D1071199
  • Facility Name: SCPMG ALTON SAND CANYON MOB 2
  • Facility Address: 6650 ALTON PARKWAY
    IRVINE, CA
    ZIP 92618
  • Facility Phone: 949 932-6110
  • Facility Type: Health Main. Organization
  • Facility Type: Microscopy
  • Lab Director: ADAM SPIVACK
  • NPI Number: 1821670084
  • Taxonomy: 207Y00000X - Otolaryngology

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CLIA Record

Field Name Field Value
CLIA Number 05D1071199
LAB Type Health Main. Organization
Facility Name SCPMG ALTON SAND CANYON MOB 2
Street 6650 ALTON PARKWAY
City IRVINE
State CA
ZIP 92618
Phone 949 932-6110
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/10/2024
Certificate Expiration Date 5/9/2026
Facility Type Health Main. Organization
Lab Director ADAM SPIVACK

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