05D2117797 CLIA NUMBER - PALMDALE CONGREGATE LIVING INC.

Laboratory Demographics

  • CLIA Code: 05D2117797
  • Facility Name: PALMDALE CONGREGATE LIVING INC.
  • Facility Address: 38702 12TH ST E
    PALMDALE, CA
    ZIP 93550
  • Facility Phone: 818 731-4664
  • Facility Type: Other - CONGREGATE LVL HLTH S
  • Facility Type: Waiver
  • Lab Director: DODDANNA KRISHNA, MD
  • NPI Number: 1134510530
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2117797
LAB Type Other - CONGREGATE LVL HLTH S
Facility Name PALMDALE CONGREGATE LIVING INC.
Street 38702 12TH ST E
City PALMDALE
State CA
ZIP 93550
Phone 818 731-4664
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2024
Certificate Expiration Date 8/22/2026
Facility Type Other - CONGREGATE LVL HLTH S
Lab Director DODDANNA KRISHNA, MD

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