05D0611472 CLIA NUMBER - FMC DIALYSIS OF SANTA ROSA

Laboratory Demographics

CLIA Number: 05D0611472

Facility Name: FMC DIALYSIS OF SANTA ROSA

Facility Address:
1020 SECOND STREET
SANTA ROSA, CA
ZIP 95404
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Facility Phone Number: 707 527-5350

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1205948007

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0611472
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FMC DIALYSIS OF SANTA ROSA
Street	1020 SECOND STREET
City	SANTA ROSA
State	CA
ZIP	95404
Phone	707 527-5350
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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