05D2128373 CLIA NUMBER - CENTINELA MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2128373
  • Facility Name: CENTINELA MEDICAL GROUP
  • Facility Address: 4405 S MAIN ST
    LOS ANGELES, CA
    ZIP 90037
  • Facility Phone: 323 231-0659
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HAZEL MCKILLOP, MD
  • NPI Number: 1902215577
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 05D2128373
LAB Type Physician Office
Facility Name CENTINELA MEDICAL GROUP
Street 4405 S MAIN ST
City LOS ANGELES
State CA
ZIP 90037
Phone 323 231-0659
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Physician Office
Lab Director HAZEL MCKILLOP, MD

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