CLIA lab
CLIA 05D1082751: Providence Plaza 25000 Dermatology
Fullerton, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D1082751 belongs to Providence Plaza 25000 Dermatology in Fullerton, CA.
Certificate of Compliance, effective December 15, 2024, expires December 14, 2026.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Compliance
- Certificate effective
- December 15, 2024
- Certificate expiration
- December 14, 2026
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- April 17, 2008
- Facility type
- Physician office
- Ownership (control type)
- Religious affiliation
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 05D1082751
- Lab name
- Providence Plaza 25000 Dermatology
- Address
- 2141 N Harbor Blvd, Ste 25000, Fullerton, CA 92835
- Phone
- (714) 626-8650
- Fax
- (714) 626-8696
Annual test volume the lab reported
- Waived tests
- 500
- Provider-performed microscopy tests
- 300
- Other nonwaived tests
- 2,322
- Total
- 3,122
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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Related
Questions
What is the CLIA number for Providence Plaza 25000 Dermatology in Fullerton?
05D1082751, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Providence Plaza 25000 Dermatology hold?
A Certificate of Compliance, according to the CMS file.
When does CLIA 05D1082751 expire?
The CMS file lists December 14, 2026 as the certificate expiration date; the certificate took effect December 15, 2024.