05D1075714 CLIA NUMBER - ST PAULS PACE

Laboratory Demographics

  • CLIA Code: 05D1075714
  • Facility Name: ST PAULS PACE
  • Facility Address: 111 ELM STREET
    SAN DIEGO, CA
    ZIP 92101
  • Facility Phone: 619 677-3800
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: VICTOR LEE
  • NPI Number: 1386987915
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1075714
LAB Type Community Clinic
Facility Name ST PAULS PACE
Street 111 ELM STREET
City SAN DIEGO
State CA
ZIP 92101
Phone 619 677-3800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Community Clinic
Lab Director VICTOR LEE

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