05D2194756 CLIA NUMBER - PACIFIC COAST SURGICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2194756
  • Facility Name: PACIFIC COAST SURGICAL GROUP
  • Facility Address: 4033 3RD AVE SUITE 204
    SAN DIEGO, CA
    ZIP 92103
  • Facility Phone: 619 295-8677
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRET J. LANGENBERG
  • NPI Number: 1326370677
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 05D2194756
LAB Type Physician Office
Facility Name PACIFIC COAST SURGICAL GROUP
Street 4033 3RD AVE SUITE 204
City SAN DIEGO
State CA
ZIP 92103
Phone 619 295-8677
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2024
Certificate Expiration Date 10/1/2026
Facility Type Physician Office
Lab Director BRET J. LANGENBERG

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