05D2293056 CLIA NUMBER - PRESTIGE SURGICAL CENTER, LLC

Laboratory Demographics

  • CLIA Code: 05D2293056
  • Facility Name: PRESTIGE SURGICAL CENTER, LLC
  • Facility Address: 18425 BURBANK BLVD STE 105A
    TARZANA, CA
    ZIP 91356
  • Facility Phone: 818 343-1401
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: HOOMAN SHABATIAN
  • NPI Number: 1902587637
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2293056
LAB Type Ambulatory Surgery Center
Facility Name PRESTIGE SURGICAL CENTER, LLC
Street 18425 BURBANK BLVD STE 105A
City TARZANA
State CA
ZIP 91356
Phone 818 343-1401
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Ambulatory Surgery Center
Lab Director HOOMAN SHABATIAN

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