05D0612188 CLIA NUMBER - ADVENTIST HEALTH CLEAR LAKE MEDICAL OFFICE

Laboratory Demographics

  • CLIA Code: 05D0612188
  • Facility Name: ADVENTIST HEALTH CLEAR LAKE MEDICAL OFFICE
  • Facility Address: 487 S MAIN ST
    LAKEPORT, CA
    ZIP 95453
  • Facility Phone: 707 995-5778
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: PARVIZ TALEBI
  • NPI Number: 1174183784
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0612188
LAB Type Rural Health Clinic
Facility Name ADVENTIST HEALTH CLEAR LAKE MEDICAL OFFICE
Street 487 S MAIN ST
City LAKEPORT
State CA
ZIP 95453
Phone 707 995-5778
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/30/2023
Certificate Expiration Date 12/29/2025
Facility Type Rural Health Clinic
Lab Director PARVIZ TALEBI

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