05D0618340 CLIA NUMBER - DIGNITY HEALTH LASSEN MEDICAL CLINIC COTTONWOOD

Laboratory Demographics

  • CLIA Code: 05D0618340
  • Facility Name: DIGNITY HEALTH LASSEN MEDICAL CLINIC COTTONWOOD
  • Facility Address: 20833 LONG BRANCH DR
    COTTONWOOD, CA
    ZIP 96022
  • Facility Phone: 530 529-8217
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: TIKOES A. BLANKENBERG
  • NPI Number: 1235672403
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0618340
LAB Type Rural Health Clinic
Facility Name DIGNITY HEALTH LASSEN MEDICAL CLINIC COTTONWOOD
Street 20833 LONG BRANCH DR
City COTTONWOOD
State CA
ZIP 96022
Phone 530 529-8217
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2024
Certificate Expiration Date 4/11/2026
Facility Type Rural Health Clinic
Lab Director TIKOES A. BLANKENBERG

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