05D2190807 CLIA NUMBER - CARBON HEALTH MEDICAL GROUP OF CALIFORNIA, PC

Laboratory Demographics

  • CLIA Code: 05D2190807
  • Facility Name: CARBON HEALTH MEDICAL GROUP OF CALIFORNIA, PC
  • Facility Address: 13365 WASHINGTON BLVD
    LOS ANGELES, CA
    ZIP 90066
  • Facility Phone: 310 504-1825
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUJAL MANDAVIA
  • NPI Number: 1275315905
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 05D2190807
LAB Type Physician Office
Facility Name CARBON HEALTH MEDICAL GROUP OF CALIFORNIA, PC
Street 13365 WASHINGTON BLVD
City LOS ANGELES
State CA
ZIP 90066
Phone 310 504-1825
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2024
Certificate Expiration Date 8/18/2026
Facility Type Physician Office
Lab Director SUJAL MANDAVIA

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This page was last updated on: 6/4/2025