05D0890246 CLIA NUMBER - MENDOCINO COAST CLINICS INC

Laboratory Demographics

CLIA Number: 05D0890246

Facility Name: MENDOCINO COAST CLINICS INC

Facility Address:
205 SOUTH ST
FORT BRAGG, CA
ZIP 95437
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Facility Phone Number: 707 964-1251

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1285128595

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0890246
LAB Type	Community Clinic
Facility Name	MENDOCINO COAST CLINICS INC
Street	205 SOUTH ST
City	FORT BRAGG
State	CA
ZIP	95437
Phone	707 964-1251
CertificateType	3
CertificateEffectiveDate	9/10/2022
CertificateExpirationDate	9/9/2024
FacilityType	PPMP

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