05D2289272 CLIA NUMBER - AE URGENT CARE - VAN NUYS

Laboratory Demographics

  • CLIA Code: 05D2289272
  • Facility Name: AE URGENT CARE - VAN NUYS
  • Facility Address: 14614 VICTORY BLVD
    VAN NUYS, CA
    ZIP 91411
  • Facility Phone: 708 417-9390
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEVIN BLANKENSHIP
  • NPI Number: 1265172266
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2289272
LAB Type Physician Office
Facility Name AE URGENT CARE - VAN NUYS
Street 14614 VICTORY BLVD
City VAN NUYS
State CA
ZIP 91411
Phone 708 417-9390
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/7/2025
Certificate Expiration Date 9/6/2027
Facility Type Physician Office
Lab Director KEVIN BLANKENSHIP

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