05D1072094 CLIA NUMBER - SHALOM MEDICAL CLINIC INC

Laboratory Demographics

  • CLIA Code: 05D1072094
  • Facility Name: SHALOM MEDICAL CLINIC INC
  • Facility Address: 1721 N WILMINGTON BLVD
    WILMINGTON, CA
    ZIP 90744
  • Facility Phone: 310 835-1414
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANGEL G. PEREZ MD
  • NPI Number: 1295940054
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1072094
LAB Type Physician Office
Facility Name SHALOM MEDICAL CLINIC INC
Street 1721 N WILMINGTON BLVD
City WILMINGTON
State CA
ZIP 90744
Phone 310 835-1414
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2024
Certificate Expiration Date 1/19/2026
Facility Type Physician Office
Lab Director ANGEL G. PEREZ MD

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