05D2130937 CLIA NUMBER - HEALTHWORKS MED GRP OF CALIFORNIA, AMC DBA THE CLINIC PREMISE HEALTH LAX

Laboratory Demographics

CLIA Number: 05D2130937

Facility Name: HEALTHWORKS MED GRP OF CALIFORNIA, AMC DBA THE CLINIC PREMISE HEALTH LAX

Facility Address:
7260 WORLD WAY W
LOS ANGELES, CA
ZIP 90045
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Facility Phone Number: 310 646-5520

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1548613474

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2130937
LAB Type	Physician Office
Facility Name	HEALTHWORKS MED GRP OF CALIFORNIA, AMC DBA THE CLINIC PREMISE HEALTH LAX
Street	7260 WORLD WAY W
City	LOS ANGELES
State	CA
ZIP	90045
Phone	310 646-5520
CertificateType	4
CertificateEffectiveDate	5/19/2023
CertificateExpirationDate	5/18/2025
FacilityType	Waiver

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