05D2314991 CLIA NUMBER - BESPOKE TREATMENT

Laboratory Demographics

  • CLIA Code: 05D2314991
  • Facility Name: BESPOKE TREATMENT
  • Facility Address: 12381 WILSHIRE BLVD STE 205
    LOS ANGELES, CA
    ZIP 90025
  • Facility Phone: 833 705-2968
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NIMA FAHIMIAN
  • NPI Number: 1356054019
  • Taxonomy: 261QM0850X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2314991
LAB Type Physician Office
Facility Name BESPOKE TREATMENT
Street 12381 WILSHIRE BLVD STE 205
City LOS ANGELES
State CA
ZIP 90025
Phone 833 705-2968
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Physician Office
Lab Director NIMA FAHIMIAN

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