05D0584061 CLIA NUMBER - GARY D WIKHOLM MD PC

Laboratory Demographics

  • CLIA Code: 05D0584061
  • Facility Name: GARY D WIKHOLM MD PC
  • Facility Address: 247 WEST HARVARD BOULEVARD
    SANTA PAULA, CA
    ZIP 93060
  • Facility Phone: 805 525-0907
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GARY D. WIKHOLM MD
  • NPI Number: 1861598526
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0584061
LAB Type Physician Office
Facility Name GARY D WIKHOLM MD PC
Street 247 WEST HARVARD BOULEVARD
City SANTA PAULA
State CA
ZIP 93060
Phone 805 525-0907
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/2/2024
Certificate Expiration Date 2/1/2026
Facility Type Physician Office
Lab Director GARY D. WIKHOLM MD

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