05D2320416 CLIA NUMBER - GRACE DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 05D2320416
  • Facility Name: GRACE DERMATOLOGY
  • Facility Address: 5122 KATELLA AVE, SUITE 307
    LOS ALAMITOS, CA
    ZIP 90720
  • Facility Phone: 562 502-7144
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LINA J. KENNEDY
  • NPI Number: 1467231811
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2320416
LAB Type Physician Office
Facility Name GRACE DERMATOLOGY
Street 5122 KATELLA AVE, SUITE 307
City LOS ALAMITOS
State CA
ZIP 90720
Phone 562 502-7144
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2025
Certificate Expiration Date 3/17/2027
Facility Type Physician Office
Lab Director LINA J. KENNEDY

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