05D0868551 CLIA NUMBER - INSTITUTE FOR HEALTH MANAGEMENT, INC

Laboratory Demographics

CLIA Number: 05D0868551

Facility Name: INSTITUTE FOR HEALTH MANAGEMENT, INC

Facility Address:
715 SOUTHPOINT BLVD SUITE C
PETALUMA, CA
ZIP 94954
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Facility Phone Number: 707 778-6019

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932321387

Taxonomy: 207RN0300X - Internal Medicine
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

CLIA Record

Field Name	Field Value
CLIA Number	05D0868551
LAB Type	Physician Office
Facility Name	INSTITUTE FOR HEALTH MANAGEMENT, INC
Street	715 SOUTHPOINT BLVD SUITE C
City	PETALUMA
State	CA
ZIP	94954
Phone	707 778-6019
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024