05D2058114 CLIA NUMBER - CAL OPTIMA PACE

Laboratory Demographics

CLIA Code: 05D2058114
Facility Name: CAL OPTIMA PACE
Facility Address: 13300 GARDEN GROVE BLVD.
GARDEN GROVE, CA
ZIP 92843
Facility Phone: 714 468-1100
Facility Type: Other - PACE CENTER CLINIC
Facility Type: Waiver
Lab Director: MILES MASATSUGU
NPI Number: 1467870543
Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

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CLIA Record

Field Name	Field Value
CLIA Number	05D2058114
LAB Type	Other - PACE CENTER CLINIC
Facility Name	CAL OPTIMA PACE
Street	13300 GARDEN GROVE BLVD.
City	GARDEN GROVE
State	CA
ZIP	92843
Phone	714 468-1100
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	4/30/2025
Certificate Expiration Date	4/29/2027
Facility Type	Other - PACE CENTER CLINIC
Lab Director	MILES MASATSUGU

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This page was last updated on: 6/4/2025