05D2105332 CLIA NUMBER - ONE MEDICAL -SPACE X

Laboratory Demographics

  • CLIA Code: 05D2105332
  • Facility Name: ONE MEDICAL -SPACE X
  • Facility Address: 3615 JACK NORTHROP AVE STE 100
    HAWTHORNE, CA
    ZIP 90250
  • Facility Phone: 888 663-6331
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JENNIFER CARLETON-NATHAN
  • NPI Number: 1922470392
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2105332
LAB Type Physician Office
Facility Name ONE MEDICAL -SPACE X
Street 3615 JACK NORTHROP AVE STE 100
City HAWTHORNE
State CA
ZIP 90250
Phone 888 663-6331
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/23/2023
Certificate Expiration Date 11/22/2025
Facility Type Physician Office
Lab Director JENNIFER CARLETON-NATHAN

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