05D2290860 CLIA NUMBER - PROVIDENCE URGENT CARE

Laboratory Demographics

  • CLIA Code: 05D2290860
  • Facility Name: PROVIDENCE URGENT CARE
  • Facility Address: 503 S BUENA VISTA ST #101
    BURBANK, CA
    ZIP 91505
  • Facility Phone: 818 869-7630
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ERIK DAVYDOV
  • NPI Number: 1093056632
  • Taxonomy: 282N00000X - General Acute Care Hospital

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D2290860
LAB Type Physician Office
Facility Name PROVIDENCE URGENT CARE
Street 503 S BUENA VISTA ST #101
City BURBANK
State CA
ZIP 91505
Phone 818 869-7630
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2023
Certificate Expiration Date 10/1/2025
Facility Type Physician Office
Lab Director ERIK DAVYDOV

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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