05D2306579 CLIA NUMBER - LOMPOC SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 05D2306579
  • Facility Name: LOMPOC SURGERY CENTER, LLC
  • Facility Address: 215 N H ST
    LOMPOC, CA
    ZIP 93436
  • Facility Phone: 805 588-7984
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RANDALL L. GOODMAN
  • NPI Number: 1396595245
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2306579
LAB Type Ambulatory Surgery Center
Facility Name LOMPOC SURGERY CENTER, LLC
Street 215 N H ST
City LOMPOC
State CA
ZIP 93436
Phone 805 588-7984
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/20/2024
Certificate Expiration Date 6/19/2026
Facility Type Ambulatory Surgery Center
Lab Director RANDALL L. GOODMAN

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