05D2153809 CLIA NUMBER - NEW VALLEY PEDIATRIC CLINIC

Laboratory Demographics

  • CLIA Code: 05D2153809
  • Facility Name: NEW VALLEY PEDIATRIC CLINIC
  • Facility Address: 1840 N HACIENDA BLVD SUITE 4
    LA PUENTE, CA
    ZIP 91744
  • Facility Phone: 626 727-2150
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHAMS MOUSAVILAR
  • NPI Number: 1003301573
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2153809
LAB Type Physician Office
Facility Name NEW VALLEY PEDIATRIC CLINIC
Street 1840 N HACIENDA BLVD SUITE 4
City LA PUENTE
State CA
ZIP 91744
Phone 626 727-2150
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/30/2024
Certificate Expiration Date 8/29/2026
Facility Type Physician Office
Lab Director SHAMS MOUSAVILAR

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