05D2054794 CLIA NUMBER - PAIN MANAGEMENT & INJURY RELIEF MEDICAL CENTER THOUSAND OAKS

Laboratory Demographics

  • CLIA Code: 05D2054794
  • Facility Name: PAIN MANAGEMENT & INJURY RELIEF MEDICAL CENTER THOUSAND OAKS
  • Facility Address: 1120 NEWBURY ROAD SUITE 150
    THOUSAND OAKS, CA
    ZIP 91320
  • Facility Phone: 805 557-0069
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALEX P. HERSEL
  • NPI Number: 1063511475
  • Taxonomy: 207LP2900X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 05D2054794
LAB Type Physician Office
Facility Name PAIN MANAGEMENT & INJURY RELIEF MEDICAL CENTER THOUSAND OAKS
Street 1120 NEWBURY ROAD SUITE 150
City THOUSAND OAKS
State CA
ZIP 91320
Phone 805 557-0069
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2025
Certificate Expiration Date 2/26/2027
Facility Type Physician Office
Lab Director ALEX P. HERSEL

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