05D0880562 CLIA NUMBER - LA CLINICA VALLEJO MEDICAL

Laboratory Demographics

  • CLIA Code: 05D0880562
  • Facility Name: LA CLINICA VALLEJO MEDICAL
  • Facility Address: 415 GEORGIA ST
    VALLEJO, CA
    ZIP 94590
  • Facility Phone: 707 556-8100
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: DR. ZOE CAPPE
  • NPI Number: 1992811392
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0880562
LAB Type Community Clinic
Facility Name LA CLINICA VALLEJO MEDICAL
Street 415 GEORGIA ST
City VALLEJO
State CA
ZIP 94590
Phone 707 556-8100
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 12/16/2023
Certificate Expiration Date 12/15/2025
Facility Type Community Clinic
Lab Director DR. ZOE CAPPE

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