05D2036433 CLIA NUMBER - NEWPORT ACADEMY OUTPATIENT

Laboratory Demographics

  • CLIA Code: 05D2036433
  • Facility Name: NEWPORT ACADEMY OUTPATIENT
  • Facility Address: 3189 PULLMAN ST
    COSTA MESA, CA
    ZIP 92626
  • Facility Phone: 714 393-3523
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: ELIZABETH M. SHANE
  • NPI Number: 1760995260
  • Taxonomy: 261QM0855X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2036433
LAB Type Comp. Outpatient Rehab Facility
Facility Name NEWPORT ACADEMY OUTPATIENT
Street 3189 PULLMAN ST
City COSTA MESA
State CA
ZIP 92626
Phone 714 393-3523
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director ELIZABETH M. SHANE

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