05D2042367 CLIA NUMBER - LAKE SAN MARCOS FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 05D2042367
  • Facility Name: LAKE SAN MARCOS FAMILY MEDICINE
  • Facility Address: 1030 LA BONITA DR STE 316
    SAN MARCOS, CA
    ZIP 92078
  • Facility Phone: 760 744-9626
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: NEIL L. HALIM MD
  • NPI Number: 1124392683
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2042367
LAB Type Physician Office
Facility Name LAKE SAN MARCOS FAMILY MEDICINE
Street 1030 LA BONITA DR STE 316
City SAN MARCOS
State CA
ZIP 92078
Phone 760 744-9626
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 6/11/2024
Certificate Expiration Date 6/10/2026
Facility Type Physician Office
Lab Director NEIL L. HALIM MD

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