05D0596508 CLIA NUMBER - WELCH ROAD INTERNAL MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 05D0596508
  • Facility Name: WELCH ROAD INTERNAL MEDICAL GROUP INC
  • Facility Address: 805 EL CAMINO TEAL #B
    PALO ALTO, CA
    ZIP 94301
  • Facility Phone: 650 329-0440
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SUSAN K. SORENSEN
  • NPI Number: 1134342371
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 05D0596508
LAB Type Physician Office
Facility Name WELCH ROAD INTERNAL MEDICAL GROUP INC
Street 805 EL CAMINO TEAL #B
City PALO ALTO
State CA
ZIP 94301
Phone 650 329-0440
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director SUSAN K. SORENSEN

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