05D1072811 CLIA NUMBER - LAKESIDE MEDICAL ORGANIZATION, A MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 05D1072811
  • Facility Name: LAKESIDE MEDICAL ORGANIZATION, A MEDICAL GROUP INC
  • Facility Address: 191 S BUENA VISTA ST, 2ND FL
    BURBANK, CA
    ZIP 91505
  • Facility Phone: 818 557-2671
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SILVIO A. DEL CASTILLO DO
  • NPI Number: 1043256027
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1072811
LAB Type Physician Office
Facility Name LAKESIDE MEDICAL ORGANIZATION, A MEDICAL GROUP INC
Street 191 S BUENA VISTA ST, 2ND FL
City BURBANK
State CA
ZIP 91505
Phone 818 557-2671
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/1/2024
Certificate Expiration Date 12/31/2025
Facility Type Physician Office
Lab Director SILVIO A. DEL CASTILLO DO

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