05D0918074 CLIA NUMBER - DIGNITY HEALTH MEDICAL FOUNDATION

Laboratory Demographics

  • CLIA Code: 05D0918074
  • Facility Name: DIGNITY HEALTH MEDICAL FOUNDATION
  • Facility Address: 528 CAPITOLA AVE
    CAPITOLA, CA
    ZIP 95010
  • Facility Phone: 916 379-2861
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ANNE MARIE JACKSON
  • NPI Number: 1740304112
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 05D0918074
LAB Type Physician Office
Facility Name DIGNITY HEALTH MEDICAL FOUNDATION
Street 528 CAPITOLA AVE
City CAPITOLA
State CA
ZIP 95010
Phone 916 379-2861
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 7/31/2024
Certificate Expiration Date 7/30/2026
Facility Type Physician Office
Lab Director ANNE MARIE JACKSON

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