05D0062682 CLIA NUMBER - PALO ALTO MEDICAL FOUNDATION CLINICAL LAB

Laboratory Demographics

CLIA Number: 05D0062682

Facility Name: PALO ALTO MEDICAL FOUNDATION CLINICAL LAB

Facility Address:
795 EL CAMINO REAL, LEE BLDG
PALO ALTO, CA
ZIP 94301
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Facility Phone Number: 650 853-5659

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Certificate of Compliance

NPI Number: 1013399989

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0062682
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	PALO ALTO MEDICAL FOUNDATION CLINICAL LAB
Street	795 EL CAMINO REAL, LEE BLDG
City	PALO ALTO
State	CA
ZIP	94301
Phone	650 853-5659
CertificateType	2
CertificateEffectiveDate	2/3/2022
CertificateExpirationDate	4/30/2024
FacilityType	Compliance

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This page was last updated on: 4/23/2024