05D0717012 CLIA NUMBER - LOS GATOS PREMIER MEDICINE

Laboratory Demographics

  • CLIA Code: 05D0717012
  • Facility Name: LOS GATOS PREMIER MEDICINE
  • Facility Address: 15251 NATIONAL AVE, SUITE 104
    LOS GATOS, CA
    ZIP 95032
  • Facility Phone: 408 358-7360
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JENNIFER HAGGERTY
  • NPI Number: 1710455639
  • Taxonomy: 106H00000X - Marriage & Family Therapist

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CLIA Record

Field Name Field Value
CLIA Number 05D0717012
LAB Type Physician Office
Facility Name LOS GATOS PREMIER MEDICINE
Street 15251 NATIONAL AVE, SUITE 104
City LOS GATOS
State CA
ZIP 95032
Phone 408 358-7360
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director JENNIFER HAGGERTY

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