05D0895558 CLIA NUMBER - SEBASTOPOL AMBULATORY SURGERY CTR LP

Laboratory Demographics

  • CLIA Code: 05D0895558
  • Facility Name: SEBASTOPOL AMBULATORY SURGERY CTR LP
  • Facility Address: 6880 PALM AVENUE
    SEBASTOPOL, CA
    ZIP 95472
  • Facility Phone: 707 823-7628
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: TAMARA C. SUSLOV MD
  • NPI Number: 1154440972
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0895558
LAB Type Ambulatory Surgery Center
Facility Name SEBASTOPOL AMBULATORY SURGERY CTR LP
Street 6880 PALM AVENUE
City SEBASTOPOL
State CA
ZIP 95472
Phone 707 823-7628
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2024
Certificate Expiration Date 12/11/2026
Facility Type Ambulatory Surgery Center
Lab Director TAMARA C. SUSLOV MD

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