05D2124069 CLIA NUMBER - JACK AZAD MD INC

Laboratory Demographics

CLIA Number: 05D2124069

Facility Name: JACK AZAD MD INC

Facility Address:
11900 AVALON BLVD STE 101
LOS ANGELES, CA
ZIP 90061
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Facility Phone Number: 323 880-8048

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1891795613

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

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
CertificateType	3
CertificateEffectiveDate	1/9/2023
CertificateExpirationDate	1/8/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024