05D2303877 CLIA NUMBER - RYANRAE SKIN DBA LAGUNA ALLERGY MEDICAL BOUTIQUE

Laboratory Demographics

  • CLIA Code: 05D2303877
  • Facility Name: RYANRAE SKIN DBA LAGUNA ALLERGY MEDICAL BOUTIQUE
  • Facility Address: 2 JOURNEY, STE 201
    ALISO VIEJO, CA
    ZIP 92656
  • Facility Phone: 949 287-4900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GILLIAN G. BASSIRPOUR
  • NPI Number: 1578340907
  • Taxonomy: 207KA0200X - Allergy & Immunology

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CLIA Record

Field Name Field Value
CLIA Number 05D2303877
LAB Type Physician Office
Facility Name RYANRAE SKIN DBA LAGUNA ALLERGY MEDICAL BOUTIQUE
Street 2 JOURNEY, STE 201
City ALISO VIEJO
State CA
ZIP 92656
Phone 949 287-4900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2024
Certificate Expiration Date 5/1/2026
Facility Type Physician Office
Lab Director GILLIAN G. BASSIRPOUR

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