05D2256639 CLIA NUMBER - PISMO BEACH PEDIATRIC CENTER

Laboratory Demographics

  • CLIA Code: 05D2256639
  • Facility Name: PISMO BEACH PEDIATRIC CENTER
  • Facility Address: 2 JAMES WAY SUITE 209
    PISMO BEACH, CA
    ZIP 93449
  • Facility Phone: 805 549-6915
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: DR. ASHIE TAM
  • NPI Number: 1538618590
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2256639
LAB Type Community Clinic
Facility Name PISMO BEACH PEDIATRIC CENTER
Street 2 JAMES WAY SUITE 209
City PISMO BEACH
State CA
ZIP 93449
Phone 805 549-6915
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2024
Certificate Expiration Date 3/24/2026
Facility Type Community Clinic
Lab Director DR. ASHIE TAM

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This page was last updated on: 6/4/2025