05D2040421 CLIA NUMBER - WESTSIDE HEAD AND NECK

Laboratory Demographics

  • CLIA Code: 05D2040421
  • Facility Name: WESTSIDE HEAD AND NECK
  • Facility Address: 3831 HUGHES AVE STE 504
    CULVER CITY, CA
    ZIP 90232
  • Facility Phone: 310 204-4111
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHELLE PUTNAM
  • NPI Number: 1508174871
  • Taxonomy: 207Y00000X - Otolaryngology

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CLIA Record

Field Name Field Value
CLIA Number 05D2040421
LAB Type Physician Office
Facility Name WESTSIDE HEAD AND NECK
Street 3831 HUGHES AVE STE 504
City CULVER CITY
State CA
ZIP 90232
Phone 310 204-4111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2024
Certificate Expiration Date 4/29/2026
Facility Type Physician Office
Lab Director MICHELLE PUTNAM

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