05D2042309 CLIA NUMBER - PACIFIC DERMATOLOGY & COSMETIC LASER CENTER

Laboratory Demographics

  • CLIA Code: 05D2042309
  • Facility Name: PACIFIC DERMATOLOGY & COSMETIC LASER CENTER
  • Facility Address: 8899 UNIVERSITY CENTER LANE STE 150
    SAN DIEGO, CA
    ZIP 92122
  • Facility Phone: 858 535-1400
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DOUGLAS M. KEEL
  • NPI Number: 1285961623
  • Taxonomy: 207NS0135X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 05D2042309
LAB Type Physician Office
Facility Name PACIFIC DERMATOLOGY & COSMETIC LASER CENTER
Street 8899 UNIVERSITY CENTER LANE STE 150
City SAN DIEGO
State CA
ZIP 92122
Phone 858 535-1400
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/8/2024
Certificate Expiration Date 6/7/2026
Facility Type Physician Office
Lab Director DOUGLAS M. KEEL

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