05D2096693 CLIA NUMBER - PROACTIVE CARE POST ACUTE

Laboratory Demographics

  • CLIA Code: 05D2096693
  • Facility Name: PROACTIVE CARE POST ACUTE
  • Facility Address: 17822 BEACH BLVD, STE 400
    HUNTINGTON BEACH, CA
    ZIP 92647
  • Facility Phone: 714 982-7048
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: AGUILIZ AMABLE
  • NPI Number: 1902203441
  • Taxonomy: 363LG0600X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 05D2096693
LAB Type Practitioner Other
Facility Name PROACTIVE CARE POST ACUTE
Street 17822 BEACH BLVD, STE 400
City HUNTINGTON BEACH
State CA
ZIP 92647
Phone 714 982-7048
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/29/2025
Certificate Expiration Date 5/28/2027
Facility Type Practitioner Other
Lab Director AGUILIZ AMABLE

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