05D2185531 CLIA NUMBER - LA VIDA HOSPICE, INC

Laboratory Demographics

  • CLIA Code: 05D2185531
  • Facility Name: LA VIDA HOSPICE, INC
  • Facility Address: 732 WEST 9TH STRET SUITE 202
    SAN PEDRO, CA
    ZIP 90731
  • Facility Phone: 424 570-1481
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: MARK WAGNER
  • NPI Number: 1336663251
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2185531
LAB Type Hospice
Facility Name LA VIDA HOSPICE, INC
Street 732 WEST 9TH STRET SUITE 202
City SAN PEDRO
State CA
ZIP 90731
Phone 424 570-1481
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/4/2024
Certificate Expiration Date 6/3/2026
Facility Type Hospice
Lab Director MARK WAGNER

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