05D2078397 CLIA NUMBER - SOCAL ADVANCED UROLOGY

Laboratory Demographics

  • CLIA Code: 05D2078397
  • Facility Name: SOCAL ADVANCED UROLOGY
  • Facility Address: 1141 W REDONDO BEACH BLVD STE 303
    GARDENA, CA
    ZIP 90247
  • Facility Phone: 310 538-2930
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: NOWZARI FARSHAD
  • NPI Number: 1700294386
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 05D2078397
LAB Type Physician Office
Facility Name SOCAL ADVANCED UROLOGY
Street 1141 W REDONDO BEACH BLVD STE 303
City GARDENA
State CA
ZIP 90247
Phone 310 538-2930
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/27/2024
Certificate Expiration Date 5/26/2026
Facility Type Physician Office
Lab Director NOWZARI FARSHAD

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