05D1096665 CLIA NUMBER - COASTAL COMMUNITIES PHYSICIAN NETWORK

Laboratory Demographics

  • CLIA Code: 05D1096665
  • Facility Name: COASTAL COMMUNITIES PHYSICIAN NETWORK
  • Facility Address: 35 CASA ST STE 170
    SAN LUIS OBISPO, CA
    ZIP 93405
  • Facility Phone: 661 616-9416
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ARDESHIR TALIEH, MD
  • NPI Number: 1275735011
  • Taxonomy: 302R00000X - Health Maintenance Organization

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CLIA Record

Field Name Field Value
CLIA Number 05D1096665
LAB Type Physician Office
Facility Name COASTAL COMMUNITIES PHYSICIAN NETWORK
Street 35 CASA ST STE 170
City SAN LUIS OBISPO
State CA
ZIP 93405
Phone 661 616-9416
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2025
Certificate Expiration Date 3/6/2027
Facility Type Physician Office
Lab Director ARDESHIR TALIEH, MD

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