05D2153169 CLIA NUMBER - PACIFIC SURGICAL SUITE LLC

Laboratory Demographics

  • CLIA Code: 05D2153169
  • Facility Name: PACIFIC SURGICAL SUITE LLC
  • Facility Address: 558 ST CHARLES STE 200
    THOUSAND OAKS, CA
    ZIP 91360
  • Facility Phone: 805 379-2322
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ERIK C. SPAYDE, MD
  • NPI Number: 1518452531
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2153169
LAB Type Ambulatory Surgery Center
Facility Name PACIFIC SURGICAL SUITE LLC
Street 558 ST CHARLES STE 200
City THOUSAND OAKS
State CA
ZIP 91360
Phone 805 379-2322
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2024
Certificate Expiration Date 8/21/2026
Facility Type Ambulatory Surgery Center
Lab Director ERIK C. SPAYDE, MD

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