05D0680480 CLIA NUMBER - GOLDEN GATEIDENCE OPCO, LLC VICTORIAN POST ACUTE

Laboratory Demographics

  • CLIA Code: 05D0680480
  • Facility Name: GOLDEN GATEIDENCE OPCO, LLC VICTORIAN POST ACUTE
  • Facility Address: 2121 PINE STREET
    SAN FRANCISCO, CA
    ZIP 94115
  • Facility Phone: 415 922-5085
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: STEFANI L. WEDL, MD
  • NPI Number: 1679665350
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0680480
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name GOLDEN GATEIDENCE OPCO, LLC VICTORIAN POST ACUTE
Street 2121 PINE STREET
City SAN FRANCISCO
State CA
ZIP 94115
Phone 415 922-5085
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director STEFANI L. WEDL, MD

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