05D2053984 CLIA NUMBER - BASTYR UNIVERSITY CLINIC

Laboratory Demographics

  • CLIA Code: 05D2053984
  • Facility Name: BASTYR UNIVERSITY CLINIC
  • Facility Address: 4110 SORRENTO VALLEY BLVD
    SAN DIEGO, CA
    ZIP 92121
  • Facility Phone: 858 246-9730
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MAYA ROTH
  • NPI Number: 1104160043
  • Taxonomy: 175F00000X - Naturopath

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CLIA Record

Field Name Field Value
CLIA Number 05D2053984
LAB Type Practitioner Other
Facility Name BASTYR UNIVERSITY CLINIC
Street 4110 SORRENTO VALLEY BLVD
City SAN DIEGO
State CA
ZIP 92121
Phone 858 246-9730
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2023
Certificate Expiration Date 12/21/2025
Facility Type Practitioner Other
Lab Director MAYA ROTH

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