05D2107462 CLIA NUMBER - DIRECTED INTERVENTIONAL SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 05D2107462
  • Facility Name: DIRECTED INTERVENTIONAL SURGERY CENTER
  • Facility Address: 2827 WILSHIRE BLVD
    SANTA MONICA, CA
    ZIP 90403
  • Facility Phone: 310 829-9788
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: BRADLEY JABOUR, MD
  • NPI Number: 1679694392
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2107462
LAB Type Ambulatory Surgery Center
Facility Name DIRECTED INTERVENTIONAL SURGERY CENTER
Street 2827 WILSHIRE BLVD
City SANTA MONICA
State CA
ZIP 90403
Phone 310 829-9788
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/14/2024
Certificate Expiration Date 1/13/2026
Facility Type Ambulatory Surgery Center
Lab Director BRADLEY JABOUR, MD

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