05D2192552 CLIA NUMBER - USRC NORTH HOLLYWOOD, LLC DBA US RENAL CARE NORTH HOLLYWOOD DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2192552
  • Facility Name: USRC NORTH HOLLYWOOD, LLC DBA US RENAL CARE NORTH HOLLYWOOD DIALYSIS
  • Facility Address: 13019 VICTORY BLVD
    N HOLLYWOOD, CA
    ZIP 91606
  • Facility Phone: 323 678-4840
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JACOB POULOSE
  • NPI Number: 1982215323
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2192552
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name USRC NORTH HOLLYWOOD, LLC DBA US RENAL CARE NORTH HOLLYWOOD DIALYSIS
Street 13019 VICTORY BLVD
City N HOLLYWOOD
State CA
ZIP 91606
Phone 323 678-4840
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2024
Certificate Expiration Date 9/10/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JACOB POULOSE

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