05D2107957 CLIA NUMBER - PROVIDENCE SAINT JOHN'S MEDICAL FOUNDATION DBA SAINT JOHN'S PHYSICIAN PARTNERS

Laboratory Demographics

  • CLIA Code: 05D2107957
  • Facility Name: PROVIDENCE SAINT JOHN'S MEDICAL FOUNDATION DBA SAINT JOHN'S PHYSICIAN PARTNERS
  • Facility Address: 901 WILSHIRE BLVD STE 100
    SANTA MONICA, CA
    ZIP 90401
  • Facility Phone: 213 712-7765
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RICHARD ROSS
  • NPI Number: 1639204373
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2107957
LAB Type Physician Office
Facility Name PROVIDENCE SAINT JOHN'S MEDICAL FOUNDATION DBA SAINT JOHN'S PHYSICIAN PARTNERS
Street 901 WILSHIRE BLVD STE 100
City SANTA MONICA
State CA
ZIP 90401
Phone 213 712-7765
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 1/26/2024
Certificate Expiration Date 1/25/2026
Facility Type Physician Office
Lab Director RICHARD ROSS

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This page was last updated on: 6/4/2025