05D2025580 CLIA NUMBER - WISTERIA HOSPICE INC

Laboratory Demographics

  • CLIA Code: 05D2025580
  • Facility Name: WISTERIA HOSPICE INC
  • Facility Address: 4195 N VIKING WAY STE 140
    LONG BEACH, CA
    ZIP 90808
  • Facility Phone: 562 425-1203
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: NESTOR LAZARO
  • NPI Number: 1346544848
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2025580
LAB Type Hospice
Facility Name WISTERIA HOSPICE INC
Street 4195 N VIKING WAY STE 140
City LONG BEACH
State CA
ZIP 90808
Phone 562 425-1203
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2025
Certificate Expiration Date 6/12/2027
Facility Type Hospice
Lab Director NESTOR LAZARO

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