05D1100580 CLIA NUMBER - SEASIDE MEDICAL PRACTICE

Laboratory Demographics

  • CLIA Code: 05D1100580
  • Facility Name: SEASIDE MEDICAL PRACTICE
  • Facility Address: 2319 WILSHIRE BLVD
    SANTA MONICA, CA
    ZIP 90403
  • Facility Phone: 310 393-5000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NASIMEH YAZDANI
  • NPI Number: 1528203999
  • Taxonomy: 207RN0300X - Internal Medicine

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/21/2024
Certificate Expiration Date 7/20/2026
Facility Type Physician Office
Lab Director NASIMEH YAZDANI

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