05D2100782 CLIA NUMBER - BEVERLYWOOD DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2100782
  • Facility Name: BEVERLYWOOD DIALYSIS
  • Facility Address: 2080 CENTURY PARK E STE 210
    LOS ANGELES, CA
    ZIP 90067
  • Facility Phone: 562 426-7062
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: LARRY FROCH
  • NPI Number: 1306243209
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2100782
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name BEVERLYWOOD DIALYSIS
Street 2080 CENTURY PARK E STE 210
City LOS ANGELES
State CA
ZIP 90067
Phone 562 426-7062
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2025
Certificate Expiration Date 8/20/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director LARRY FROCH

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