05D2230472 CLIA NUMBER - GENESIS PROGRAM VIN# 3FA6POLU5KR277935

Laboratory Demographics

  • CLIA Code: 05D2230472
  • Facility Name: GENESIS PROGRAM VIN# 3FA6POLU5KR277935
  • Facility Address: 510 S VERMONT AVE, 17TH FL
    LOS ANGELES, CA
    ZIP 90020
  • Facility Phone: 213 738-4725
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: TAYA VARTERESIAN
  • NPI Number: 1083944078
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2230472
LAB Type Mobile Laboratory
Facility Name GENESIS PROGRAM VIN# 3FA6POLU5KR277935
Street 510 S VERMONT AVE, 17TH FL
City LOS ANGELES
State CA
ZIP 90020
Phone 213 738-4725
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2025
Certificate Expiration Date 7/22/2027
Facility Type Mobile Laboratory
Lab Director TAYA VARTERESIAN

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