05D2297228 CLIA NUMBER - DYNASTY HOSPICE, INC.

Laboratory Demographics

  • CLIA Code: 05D2297228
  • Facility Name: DYNASTY HOSPICE, INC.
  • Facility Address: 14640 VICTORY BLVD #207A
    VAN NUYS, CA
    ZIP 91411
  • Facility Phone: 747 285-2120
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: CLEM RODRIGUEZ
  • NPI Number: 1083226963
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 05D2297228
LAB Type Hospice
Facility Name DYNASTY HOSPICE, INC.
Street 14640 VICTORY BLVD #207A
City VAN NUYS
State CA
ZIP 91411
Phone 747 285-2120
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2024
Certificate Expiration Date 1/10/2026
Facility Type Hospice
Lab Director CLEM RODRIGUEZ

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