05D2058113 CLIA NUMBER - Wallace Medical Group, Inc

Laboratory Demographics

CLIA Number: 05D2058113

Facility Name: Wallace Medical Group, Inc

Facility Address:
8920 Wilshire Blvd.,Ste 327,
Beverly Hills, CA
ZIP 90211
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Facility Phone Number: (310) 652-8460

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1104047596

Taxonomy: 207NS0135X - Dermatology
Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers).

CLIA Record

Field Name Field Value
CLIA Number 05D2058113
LAB Type PHYSICIAN OFFICE
Facility Name Wallace Medical Group, Inc
Street 8920 Wilshire Blvd.,Ste 327,
City Beverly Hills
State CA
ZIP 90211
Phone 3106528460

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This page was last updated on: 5/19/2019