05D0906548 CLIA NUMBER - SAN BENITO COMMUNITY HEALTH CLINIC

Laboratory Demographics

CLIA Number: 05D0906548

Facility Name: SAN BENITO COMMUNITY HEALTH CLINIC

Facility Address:
930 SUNSET DR, BLDG 3
HOLLISTER, CA
ZIP 95023
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Facility Phone Number: 831 636-2664

Facility Type: Other - HOSPITAL BASED OFFICE

Certificate Type: Waiver

NPI Number: 1033235973

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0906548
LAB Type	Other - HOSPITAL BASED OFFICE
Facility Name	SAN BENITO COMMUNITY HEALTH CLINIC
Street	930 SUNSET DR, BLDG 3
City	HOLLISTER
State	CA
ZIP	95023
Phone	831 636-2664
CertificateType	4
CertificateEffectiveDate	10/12/2022
CertificateExpirationDate	10/11/2024
FacilityType	Waiver

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