05D1100580 CLIA NUMBER - SEASIDE MEDICAL PRACTICE

Laboratory Demographics

CLIA Number: 05D1100580

Facility Name: SEASIDE MEDICAL PRACTICE

Facility Address:
2319 WILSHIRE BLVD
SANTA MONICA, CA
ZIP 90403
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Facility Phone Number: 310 393-5000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154376580

Taxonomy: 207RN0300X - Internal Medicine
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

CLIA Record

Field Name	Field Value
CLIA Number	05D1100580
LAB Type	Physician Office
Facility Name	SEASIDE MEDICAL PRACTICE
Street	2319 WILSHIRE BLVD
City	SANTA MONICA
State	CA
ZIP	90403
Phone	310 393-5000
CertificateType	4
CertificateEffectiveDate	7/21/2022
CertificateExpirationDate	7/20/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024