05D2150589 CLIA NUMBER - 12 SOUTH LLC

Laboratory Demographics

  • CLIA Code: 05D2150589
  • Facility Name: 12 SOUTH LLC
  • Facility Address: 23712 BIRTCHER DR
    LAKE FOREST, CA
    ZIP 92630
  • Facility Phone: 888 830-8374
  • Facility Type: Other - OUTPATIENT TREATMENT CTR
  • Facility Type: Waiver
  • Lab Director: ALEJANDRO ALVA MD
  • NPI Number: 1154789766
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2150589
LAB Type Other - OUTPATIENT TREATMENT CTR
Facility Name 12 SOUTH LLC
Street 23712 BIRTCHER DR
City LAKE FOREST
State CA
ZIP 92630
Phone 888 830-8374
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/27/2024
Certificate Expiration Date 6/26/2026
Facility Type Other - OUTPATIENT TREATMENT CTR
Lab Director ALEJANDRO ALVA MD

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