05D1073514 CLIA NUMBER - PACIFIC COAST SPINE INSTITUTE AND PAIN CENTER

Laboratory Demographics

  • CLIA Code: 05D1073514
  • Facility Name: PACIFIC COAST SPINE INSTITUTE AND PAIN CENTER
  • Facility Address: 17822 BEACH BLVD #101
    HUNTINGTON BEACH, CA
    ZIP 92647
  • Facility Phone: 714 847-3666
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MARYAM RAHBAR MD
  • NPI Number: 1245393602
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1073514
LAB Type Ambulatory Surgery Center
Facility Name PACIFIC COAST SPINE INSTITUTE AND PAIN CENTER
Street 17822 BEACH BLVD #101
City HUNTINGTON BEACH
State CA
ZIP 92647
Phone 714 847-3666
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2025
Certificate Expiration Date 9/10/2027
Facility Type Ambulatory Surgery Center
Lab Director MARYAM RAHBAR MD

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