05D0596508 CLIA NUMBER - WELCH ROAD INTERNAL MEDICAL GROUP INC

Laboratory Demographics

CLIA Number: 05D0596508

Facility Name: WELCH ROAD INTERNAL MEDICAL GROUP INC

Facility Address:
805 EL CAMINO TEAL #B
PALO ALTO, CA
ZIP 94301
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Facility Phone Number: 650 329-0440

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1134342371

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

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
CertificateType	3
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	PPMP

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