05D0901413 CLIA NUMBER - ADVENTIST HEALTH CLEAR LAKE MEDICAL OFFICE

Laboratory Demographics

  • CLIA Code: 05D0901413
  • Facility Name: ADVENTIST HEALTH CLEAR LAKE MEDICAL OFFICE
  • Facility Address: 15230 LAKE SHORE DRIVE
    CLEARLAKE, CA
    ZIP 95422
  • Facility Phone: 707 995-4500
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: MARC SHAPIRO
  • NPI Number: 1992242614
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0901413
LAB Type Rural Health Clinic
Facility Name ADVENTIST HEALTH CLEAR LAKE MEDICAL OFFICE
Street 15230 LAKE SHORE DRIVE
City CLEARLAKE
State CA
ZIP 95422
Phone 707 995-4500
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 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Rural Health Clinic
Lab Director MARC SHAPIRO

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