05D2055590 CLIA NUMBER - SAN DIEGO SKIN INC

Laboratory Demographics

  • CLIA Code: 05D2055590
  • Facility Name: SAN DIEGO SKIN INC
  • Facility Address: 4150 REGENTS PARK ROW STE 300
    LA JOLLA, CA
    ZIP 92037
  • Facility Phone: 858 909-9000
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MARK M. MOFID
  • NPI Number: 1972831998
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2055590
LAB Type Ambulatory Surgery Center
Facility Name SAN DIEGO SKIN INC
Street 4150 REGENTS PARK ROW STE 300
City LA JOLLA
State CA
ZIP 92037
Phone 858 909-9000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2025
Certificate Expiration Date 3/13/2027
Facility Type Ambulatory Surgery Center
Lab Director MARK M. MOFID

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