05D2121881 CLIA NUMBER - MISSION CITY COMMUNITY NETWORK INC - FAIRFAX

Laboratory Demographics

  • CLIA Code: 05D2121881
  • Facility Name: MISSION CITY COMMUNITY NETWORK INC - FAIRFAX
  • Facility Address: 359 N FAIRFAX AVE
    LOS ANGELES, CA
    ZIP 90036
  • Facility Phone: 818 895-3100
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: JOHN CHARD
  • NPI Number: 1730428293
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2121881
LAB Type Community Clinic
Facility Name MISSION CITY COMMUNITY NETWORK INC - FAIRFAX
Street 359 N FAIRFAX AVE
City LOS ANGELES
State CA
ZIP 90036
Phone 818 895-3100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2024
Certificate Expiration Date 11/14/2026
Facility Type Community Clinic
Lab Director JOHN CHARD

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