05D2210083 CLIA NUMBER - PAYMAN R EMMANUEL MD INC

Laboratory Demographics

CLIA Number: 05D2210083

Facility Name: PAYMAN R EMMANUEL MD INC

Facility Address:
10750 WASHINGTON BLVD
CULVER CITY, CA
ZIP 90232
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Facility Phone Number: 310 253-9999

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1831132422

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D2210083
LAB Type	Physician Office
Facility Name	PAYMAN R EMMANUEL MD INC
Street	10750 WASHINGTON BLVD
City	CULVER CITY
State	CA
ZIP	90232
Phone	310 253-9999
CertificateType	4
CertificateEffectiveDate	1/19/2023
CertificateExpirationDate	1/18/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024