05D0890527 CLIA NUMBER - PELICAN BAY STATE PRISON CLINICAL LAB

Laboratory Demographics

  • CLIA Code: 05D0890527
  • Facility Name: PELICAN BAY STATE PRISON CLINICAL LAB
  • Facility Address: 5905 LAKE EARL DR
    CRESCENT CITY, CA
    ZIP 95532
  • Facility Phone: 707 464-9179
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: BAL JASDEEP
  • NPI Number: 1437280153
  • Taxonomy: 261QP2400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0890527
LAB Type Prison
Facility Name PELICAN BAY STATE PRISON CLINICAL LAB
Street 5905 LAKE EARL DR
City CRESCENT CITY
State CA
ZIP 95532
Phone 707 464-9179
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/23/2024
Certificate Expiration Date 6/22/2026
Facility Type Prison
Lab Director BAL JASDEEP

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