05D2281427 CLIA NUMBER - PERSONALIZED PEDIATRIC LABORATORIES

Laboratory Demographics

  • CLIA Code: 05D2281427
  • Facility Name: PERSONALIZED PEDIATRIC LABORATORIES
  • Facility Address: 1744 BERKELEY ST
    SANTA MONICA, CA
    ZIP 90404
  • Facility Phone: 725 240-0608
  • Facility Type: Independent
  • Facility Type: Accreditation
  • Lab Director: DR. PHOUTHASONE THIRAKUL
  • NPI Number: 1194416628
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 05D2281427
LAB Type Independent
Facility Name PERSONALIZED PEDIATRIC LABORATORIES
Street 1744 BERKELEY ST
City SANTA MONICA
State CA
ZIP 90404
Phone 725 240-0608
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 12/5/2023
Certificate Expiration Date 12/4/2025
Facility Type Independent
Lab Director DR. PHOUTHASONE THIRAKUL

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