05D2195656 CLIA NUMBER - WAEL KOULI MD PC

Laboratory Demographics

  • CLIA Code: 05D2195656
  • Facility Name: WAEL KOULI MD PC
  • Facility Address: 120 C AVENUE SUITE #130
    CORONADO, CA
    ZIP 92118
  • Facility Phone: 619 435-5880
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: WAEL KOULI
  • NPI Number: 1104929215
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 05D2195656
LAB Type Ambulatory Surgery Center
Facility Name WAEL KOULI MD PC
Street 120 C AVENUE SUITE #130
City CORONADO
State CA
ZIP 92118
Phone 619 435-5880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2024
Certificate Expiration Date 10/10/2026
Facility Type Ambulatory Surgery Center
Lab Director WAEL KOULI

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