05D2106319 CLIA NUMBER - LOS ANGELES HEMATOLOGY ONCOLOGY MED GRP

Laboratory Demographics

CLIA Number: 05D2106319

Facility Name: LOS ANGELES HEMATOLOGY ONCOLOGY MED GRP

Facility Address:
222 EULALIA ST STE 100C
GLENDALE, CA
ZIP 91204
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Facility Phone Number: 818 553-8160

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1386859122

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	05D2106319
LAB Type	Physician Office
Facility Name	LOS ANGELES HEMATOLOGY ONCOLOGY MED GRP
Street	222 EULALIA ST STE 100C
City	GLENDALE
State	CA
ZIP	91204
Phone	818 553-8160
CertificateType	2
CertificateEffectiveDate	9/15/2022
CertificateExpirationDate	9/14/2024
FacilityType	Compliance

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