05D0707285 CLIA NUMBER - VISTA COMMUNITY CLINIC

Laboratory Demographics

  • CLIA Code: 05D0707285
  • Facility Name: VISTA COMMUNITY CLINIC
  • Facility Address: 134 GRAPEVINE ROAD
    VISTA, CA
    ZIP 92083
  • Facility Phone: 760 631-5000
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: SARAH FATLAND
  • NPI Number: 1578198503
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 05D0707285
LAB Type Community Clinic
Facility Name VISTA COMMUNITY CLINIC
Street 134 GRAPEVINE ROAD
City VISTA
State CA
ZIP 92083
Phone 760 631-5000
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/28/2025
Certificate Expiration Date 3/27/2027
Facility Type Community Clinic
Lab Director SARAH FATLAND

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