05D2159451 CLIA NUMBER - MISSION CITY COMMUNITY NETWORK INC

Laboratory Demographics

CLIA Number: 05D2159451

Facility Name: MISSION CITY COMMUNITY NETWORK INC

Facility Address:
5300 SANTA MONICA BLVD, STE 202
LOS ANGELES, CA
ZIP 90028
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Facility Phone Number: 818 895-3100

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1598996506

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2159451
LAB Type	Community Clinic
Facility Name	MISSION CITY COMMUNITY NETWORK INC
Street	5300 SANTA MONICA BLVD, STE 202
City	LOS ANGELES
State	CA
ZIP	90028
Phone	818 895-3100
CertificateType	4
CertificateEffectiveDate	12/18/2022
CertificateExpirationDate	12/17/2024
FacilityType	Waiver

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