05D0864786 CLIA NUMBER - CENTER FOR ELDERS INDEPENDENCE

Laboratory Demographics

CLIA Code: 05D0864786
Facility Name: CENTER FOR ELDERS INDEPENDENCE
Facility Address: 510 17TH ST
OAKLAND, CA
ZIP 94612
Facility Phone: 510 433-1150
Facility Type: Physician Office
Facility Type: Waiver
Lab Director: JAMES MITTELBERGER
NPI Number: 1245371061
Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

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CLIA Record

Field Name	Field Value
CLIA Number	05D0864786
LAB Type	Physician Office
Facility Name	CENTER FOR ELDERS INDEPENDENCE
Street	510 17TH ST
City	OAKLAND
State	CA
ZIP	94612
Phone	510 433-1150
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	JAMES MITTELBERGER

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