05D2113648 CLIA NUMBER - EL SEGUNDO DERMATOLOGY INC

Laboratory Demographics

  • CLIA Code: 05D2113648
  • Facility Name: EL SEGUNDO DERMATOLOGY INC
  • Facility Address: 713 N DOUGLAS ST
    EL SEGUNDO, CA
    ZIP 90245
  • Facility Phone: 310 906-2788
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JILL H. JAVAHERY
  • NPI Number: 1619351707
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 05D2113648
LAB Type Physician Office
Facility Name EL SEGUNDO DERMATOLOGY INC
Street 713 N DOUGLAS ST
City EL SEGUNDO
State CA
ZIP 90245
Phone 310 906-2788
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 2/9/2023
Certificate Expiration Date 10/31/2025
Facility Type Physician Office
Lab Director JILL H. JAVAHERY

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