05D2159809 CLIA NUMBER - WAVE PLASTIC SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 05D2159809
  • Facility Name: WAVE PLASTIC SURGERY CENTER
  • Facility Address: 3680 WILSHIRE BLVD SUITE 202
    LOS ANGELES, CA
    ZIP 90010
  • Facility Phone: 213 383-4800
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JONATHAN SHIFREN
  • NPI Number: 1720230840
  • Taxonomy: 284300000X - Special Hospital

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CLIA Record

Field Name Field Value
CLIA Number 05D2159809
LAB Type Ambulatory Surgery Center
Facility Name WAVE PLASTIC SURGERY CENTER
Street 3680 WILSHIRE BLVD SUITE 202
City LOS ANGELES
State CA
ZIP 90010
Phone 213 383-4800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2024
Certificate Expiration Date 12/26/2026
Facility Type Ambulatory Surgery Center
Lab Director JONATHAN SHIFREN

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