05D2041732 CLIA NUMBER - CRENSHAW COMMUNITY CLINIC

Laboratory Demographics

  • CLIA Code: 05D2041732
  • Facility Name: CRENSHAW COMMUNITY CLINIC
  • Facility Address: 3631 CRENSHAW BLVD STE 109
    LOS ANGELES, CA
    ZIP 90016
  • Facility Phone: 323 732-0100
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: OMID NASSIM MD
  • NPI Number: 1568603462
  • Taxonomy: 251B00000X - Case Management

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CLIA Record

Field Name Field Value
CLIA Number 05D2041732
LAB Type Community Clinic
Facility Name CRENSHAW COMMUNITY CLINIC
Street 3631 CRENSHAW BLVD STE 109
City LOS ANGELES
State CA
ZIP 90016
Phone 323 732-0100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/29/2024
Certificate Expiration Date 5/28/2026
Facility Type Community Clinic
Lab Director OMID NASSIM MD

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