05D2291996 CLIA NUMBER - EAGLE ROCK MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 05D2291996
  • Facility Name: EAGLE ROCK MEDICAL CENTER
  • Facility Address: 4867 EAGLE ROCK BLVD SUITE 1
    LOS ANGELES, CA
    ZIP 90041
  • Facility Phone: 818 395-2248
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AYUNA PANOSSIAN
  • NPI Number: 1932381266
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 05D2291996
LAB Type Physician Office
Facility Name EAGLE ROCK MEDICAL CENTER
Street 4867 EAGLE ROCK BLVD SUITE 1
City LOS ANGELES
State CA
ZIP 90041
Phone 818 395-2248
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2025
Certificate Expiration Date 10/17/2027
Facility Type Physician Office
Lab Director AYUNA PANOSSIAN

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