05D2124069 CLIA NUMBER - JACK AZAD MD INC

Laboratory Demographics

  • CLIA Code: 05D2124069
  • Facility Name: JACK AZAD MD INC
  • Facility Address: 11900 AVALON BLVD STE 101
    LOS ANGELES, CA
    ZIP 90061
  • Facility Phone: 323 880-8048
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JACK AZAD
  • NPI Number: 1891795613
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 05D2124069
LAB Type Physician Office
Facility Name JACK AZAD MD INC
Street 11900 AVALON BLVD STE 101
City LOS ANGELES
State CA
ZIP 90061
Phone 323 880-8048
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 1/9/2025
Certificate Expiration Date 1/8/2027
Facility Type Physician Office
Lab Director JACK AZAD

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