05D0863464 CLIA NUMBER - STEPHEN P BRADLEY, MD

Laboratory Demographics

  • CLIA Code: 05D0863464
  • Facility Name: STEPHEN P BRADLEY, MD
  • Facility Address: 5375 LAKESHORE BLVD
    LAKEPORT, CA
    ZIP 95453
  • Facility Phone: 707 263-5679
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEPHEN P. BRADLEY MD
  • NPI Number: 1699746446
  • Taxonomy: 207QA0401X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0863464
LAB Type Physician Office
Facility Name STEPHEN P BRADLEY, MD
Street 5375 LAKESHORE BLVD
City LAKEPORT
State CA
ZIP 95453
Phone 707 263-5679
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 Physician Office
Lab Director STEPHEN P. BRADLEY MD

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