05D1107255 CLIA NUMBER - SAN DIEGO PHYSIATRY AND PAIN MANAGEMENT

Laboratory Demographics

  • CLIA Code: 05D1107255
  • Facility Name: SAN DIEGO PHYSIATRY AND PAIN MANAGEMENT
  • Facility Address: 4282 GENESEE AVENUE, SUITE 304
    SAN DIEGO, CA
    ZIP 92117
  • Facility Phone: 858 514-4116
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARCIA E. ELFENBAUM, MD
  • NPI Number: 1366894354
  • Taxonomy: 332S00000X - Hearing Aid Equipment

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CLIA Record

Field Name Field Value
CLIA Number 05D1107255
LAB Type Physician Office
Facility Name SAN DIEGO PHYSIATRY AND PAIN MANAGEMENT
Street 4282 GENESEE AVENUE, SUITE 304
City SAN DIEGO
State CA
ZIP 92117
Phone 858 514-4116
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Physician Office
Lab Director MARCIA E. ELFENBAUM, MD

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