05D2178586 CLIA NUMBER - ST ANTHONY'S ADHC

Laboratory Demographics

  • CLIA Code: 05D2178586
  • Facility Name: ST ANTHONY'S ADHC
  • Facility Address: 13765 VAN NUYS BLVD
    PACOIMA, CA
    ZIP 91331
  • Facility Phone: 818 686-6733
  • Facility Type: Other - ADULT DAY HEALTH CARE
  • Facility Type: Waiver
  • Lab Director: MARVEL M. MAZMANYAN MD
  • NPI Number: 1013571710
  • Taxonomy: 261QA0600X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2178586
LAB Type Other - ADULT DAY HEALTH CARE
Facility Name ST ANTHONY'S ADHC
Street 13765 VAN NUYS BLVD
City PACOIMA
State CA
ZIP 91331
Phone 818 686-6733
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/5/2024
Certificate Expiration Date 2/4/2026
Facility Type Other - ADULT DAY HEALTH CARE
Lab Director MARVEL M. MAZMANYAN MD

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