05D2100839 CLIA NUMBER - ELITE PLASTIC SURGERY, INC.

Laboratory Demographics

  • CLIA Code: 05D2100839
  • Facility Name: ELITE PLASTIC SURGERY, INC.
  • Facility Address: 12732 W WASHINGTON BLVD STE B
    LOS ANGELES, CA
    ZIP 90066
  • Facility Phone: 256 508-6621
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: HUGHES, KENNETH, B. HUGHES, MD
  • NPI Number: 1760924005
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2100839
LAB Type Ambulatory Surgery Center
Facility Name ELITE PLASTIC SURGERY, INC.
Street 12732 W WASHINGTON BLVD STE B
City LOS ANGELES
State CA
ZIP 90066
Phone 256 508-6621
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/24/2025
Certificate Expiration Date 8/23/2027
Facility Type Ambulatory Surgery Center
Lab Director HUGHES, KENNETH, B. HUGHES, MD

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