05D2007806 CLIA NUMBER - EMILY-ANNE CENTER, INC

Laboratory Demographics

CLIA Code: 05D2007806
Facility Name: EMILY-ANNE CENTER, INC
Facility Address: 8679 CANTERBURY STREET
PANORAMA CITY, CA
ZIP 91402
Facility Phone: 818 781-7244
Facility Type: Physician Office
Facility Type: Waiver
Lab Director: FIDEL M. LARA, JR., MD
NPI Number: 1508029133
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	05D2007806
LAB Type	Physician Office
Facility Name	EMILY-ANNE CENTER, INC
Street	8679 CANTERBURY STREET
City	PANORAMA CITY
State	CA
ZIP	91402
Phone	818 781-7244
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	3/12/2025
Certificate Expiration Date	3/11/2027
Facility Type	Physician Office
Lab Director	FIDEL M. LARA, JR., MD

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