05D2096837 CLIA NUMBER - TARZANA MEDICAL URGENT CARE A PROFESSIONAL MEDICAL CORP

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Laboratory Demographics

CLIA Number: 05D2096837

Facility Name: TARZANA MEDICAL URGENT CARE A PROFESSIONAL MEDICAL CORP

Facility Address:
18055 VENTURA BLVD
ENCINO, CA
ZIP 91316
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Facility Phone Number: 818 881-8117

Facility Type: Other - URGENT CARE

Certificate Type: Waiver

NPI Number: 1568854933

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2096837
LAB Type	Other - URGENT CARE
Facility Name	TARZANA MEDICAL URGENT CARE A PROFESSIONAL MEDICAL CORP
Street	18055 VENTURA BLVD
City	ENCINO
State	CA
ZIP	91316
Phone	818 881-8117
CertificateType	4
CertificateEffectiveDate	6/2/2023
CertificateExpirationDate	6/1/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024