05D2229641 CLIA NUMBER - MOBILE STAT LAB

Laboratory Demographics

  • CLIA Code: 05D2229641
  • Facility Name: MOBILE STAT LAB
  • Facility Address: 450 BAUCHET ST
    LOS ANGELES, CA
    ZIP 90012
  • Facility Phone: 310 344-2624
  • Facility Type: Independent
  • Facility Type: Certificate of Compliance
  • Lab Director: DONALD R. SIMPSON
  • NPI Number: 1194061267
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D2229641
LAB Type Independent
Facility Name MOBILE STAT LAB
Street 450 BAUCHET ST
City LOS ANGELES
State CA
ZIP 90012
Phone 310 344-2624
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/11/2023
Certificate Expiration Date 10/31/2025
Facility Type Independent
Lab Director DONALD R. SIMPSON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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