05D2295536 CLIA NUMBER - RADY CHILDRENS HOSPITAL DERMATOLOGY CLINIC

Laboratory Demographics

CLIA Number: 05D2295536

Facility Name: RADY CHILDRENS HOSPITAL DERMATOLOGY CLINIC

Facility Address:
7910 FROST STREET SUITE 120
SAN DIEGO, CA
ZIP 92123
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Facility Phone Number: 858 966-1700

Facility Type: Other - DERMATOLOGY CLINIC

Certificate Type: Microscopy

NPI Number: 1962806166

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	05D2295536
LAB Type	Other - DERMATOLOGY CLINIC
Facility Name	RADY CHILDRENS HOSPITAL DERMATOLOGY CLINIC
Street	7910 FROST STREET SUITE 120
City	SAN DIEGO
State	CA
ZIP	92123
Phone	858 966-1700
CertificateType	3
CertificateEffectiveDate	12/13/2023
CertificateExpirationDate	12/12/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024