05D2104041 CLIA NUMBER - COAST PEDIATRICS CARMEL VALLEY

Laboratory Demographics

  • CLIA Code: 05D2104041
  • Facility Name: COAST PEDIATRICS CARMEL VALLEY
  • Facility Address: 5965 VILLAGE WAY STE 201
    SAN DIEGO, CA
    ZIP 92130
  • Facility Phone: 858 755-7337
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LORI TAYLOR
  • NPI Number: 1427434679
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D2104041
LAB Type Physician Office
Facility Name COAST PEDIATRICS CARMEL VALLEY
Street 5965 VILLAGE WAY STE 201
City SAN DIEGO
State CA
ZIP 92130
Phone 858 755-7337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Physician Office
Lab Director LORI TAYLOR

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