05D2270856 CLIA NUMBER - BEACH CITIES MEDICINE, LLC

Laboratory Demographics

  • CLIA Code: 05D2270856
  • Facility Name: BEACH CITIES MEDICINE, LLC
  • Facility Address: 520 N PROSPECT AVE SUITE 309
    REDONDO BEACH, CA
    ZIP 90277
  • Facility Phone: 424 437-4700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID H. WALLIS
  • NPI Number: 1235447392
  • Taxonomy: 207L00000X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 05D2270856
LAB Type Physician Office
Facility Name BEACH CITIES MEDICINE, LLC
Street 520 N PROSPECT AVE SUITE 309
City REDONDO BEACH
State CA
ZIP 90277
Phone 424 437-4700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2024
Certificate Expiration Date 10/20/2026
Facility Type Physician Office
Lab Director DAVID H. WALLIS

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