05D2066469 CLIA NUMBER - THEODORE B. PASTRANA JR, MD

Laboratory Demographics

  • CLIA Code: 05D2066469
  • Facility Name: THEODORE B. PASTRANA JR, MD
  • Facility Address: 1480 S HARBOR BLVD STE 16
    LA HABRA, CA
    ZIP 90631
  • Facility Phone: 714 525-4185
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THEODORE B. PASTRANA, JR
  • NPI Number: 1992747653
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2066469
LAB Type Physician Office
Facility Name THEODORE B. PASTRANA JR, MD
Street 1480 S HARBOR BLVD STE 16
City LA HABRA
State CA
ZIP 90631
Phone 714 525-4185
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/26/2023
Certificate Expiration Date 9/25/2025
Facility Type Physician Office
Lab Director THEODORE B. PASTRANA, JR

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This page was last updated on: 3/20/2025