05D2006759 CLIA NUMBER - PREMIER CARDIOLOGY INC

Laboratory Demographics

  • CLIA Code: 05D2006759
  • Facility Name: PREMIER CARDIOLOGY INC
  • Facility Address: 520 SUPERIOR AVE SUITE 330
    NEWPORT BEACH, CA
    ZIP 92663
  • Facility Phone: 949 650-4322
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MYLAVARAPU SUBBARAO
  • NPI Number: 1528202363
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2006759
LAB Type Physician Office
Facility Name PREMIER CARDIOLOGY INC
Street 520 SUPERIOR AVE SUITE 330
City NEWPORT BEACH
State CA
ZIP 92663
Phone 949 650-4322
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Physician Office
Lab Director MYLAVARAPU SUBBARAO

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