05D1077020 CLIA NUMBER - WESTSIDE PRIMARY CARE INC

Laboratory Demographics

  • CLIA Code: 05D1077020
  • Facility Name: WESTSIDE PRIMARY CARE INC
  • Facility Address: 2428 SANTA MONICA BLVD STE 402
    SANTA MONICA, CA
    ZIP 90404
  • Facility Phone: 310 829-3385
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROMANA HAIDER MD
  • NPI Number: 1073612982
  • Taxonomy: 173000000X - Legal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1077020
LAB Type Physician Office
Facility Name WESTSIDE PRIMARY CARE INC
Street 2428 SANTA MONICA BLVD STE 402
City SANTA MONICA
State CA
ZIP 90404
Phone 310 829-3385
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2024
Certificate Expiration Date 3/23/2026
Facility Type Physician Office
Lab Director ROMANA HAIDER MD

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