05D2137660 CLIA NUMBER - PIVAC ASC, LLC

Laboratory Demographics

  • CLIA Code: 05D2137660
  • Facility Name: PIVAC ASC, LLC
  • Facility Address: 6076 BRISTOL PKWY STE 108
    CULVER CITY, CA
    ZIP 90230
  • Facility Phone: 310 348-9604
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: BROWN, SPENCER, MD BROWN, SPENCER, MD
  • NPI Number: 1679010417
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2137660
LAB Type Ambulatory Surgery Center
Facility Name PIVAC ASC, LLC
Street 6076 BRISTOL PKWY STE 108
City CULVER CITY
State CA
ZIP 90230
Phone 310 348-9604
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2025
Certificate Expiration Date 10/1/2027
Facility Type Ambulatory Surgery Center
Lab Director BROWN, SPENCER, MD BROWN, SPENCER, MD

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