05D2191303 CLIA NUMBER - AVEDIS DETOX INC

Laboratory Demographics

  • CLIA Code: 05D2191303
  • Facility Name: AVEDIS DETOX INC
  • Facility Address: 1122V S CITRUS AVE
    LOS ANGELES, CA
    ZIP 90019
  • Facility Phone: 323 243-3422
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: JOHNATHAN REITMAN
  • NPI Number: 1124666334
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2191303
LAB Type Ancillary Testing Site in Health Care Center
Facility Name AVEDIS DETOX INC
Street 1122V S CITRUS AVE
City LOS ANGELES
State CA
ZIP 90019
Phone 323 243-3422
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2024
Certificate Expiration Date 11/19/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director JOHNATHAN REITMAN

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