05D1107031 CLIA NUMBER - AMY WITMAN MD, A MEDICAL CORPORATION

Laboratory Demographics

  • CLIA Code: 05D1107031
  • Facility Name: AMY WITMAN MD, A MEDICAL CORPORATION
  • Facility Address: 12395 EL CAMINO REAL SUITE 115
    SAN DIEGO, CA
    ZIP 92130
  • Facility Phone: 858 724-1313
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMY B. WITMAN
  • NPI Number: 1679670327
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1107031
LAB Type Physician Office
Facility Name AMY WITMAN MD, A MEDICAL CORPORATION
Street 12395 EL CAMINO REAL SUITE 115
City SAN DIEGO
State CA
ZIP 92130
Phone 858 724-1313
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2023
Certificate Expiration Date 10/26/2025
Facility Type Physician Office
Lab Director AMY B. WITMAN

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