05D2291142 CLIA NUMBER - TIA MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2291142
  • Facility Name: TIA MEDICAL GROUP
  • Facility Address: 12250 VENTURA BLVD
    STUDIO CITY, CA
    ZIP 91604
  • Facility Phone: 310 248-7106
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHEN-YUAN EMILY LU
  • NPI Number: 1043689904
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2291142
LAB Type Physician Office
Facility Name TIA MEDICAL GROUP
Street 12250 VENTURA BLVD
City STUDIO CITY
State CA
ZIP 91604
Phone 310 248-7106
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/5/2025
Certificate Expiration Date 10/4/2027
Facility Type Physician Office
Lab Director CHEN-YUAN EMILY LU

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