05D0919899 CLIA NUMBER - PETALUMA HEALTH CENTER

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Laboratory Demographics

CLIA Number: 05D0919899

Facility Name: PETALUMA HEALTH CENTER

Facility Address:
1179 N MCDOWELL BLVD
PETALUMA, CA
ZIP 94954
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Facility Phone Number: 707 559-7500

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1669870739

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0919899
LAB Type	Federally Qualified Health Center
Facility Name	PETALUMA HEALTH CENTER
Street	1179 N MCDOWELL BLVD
City	PETALUMA
State	CA
ZIP	94954
Phone	707 559-7500
CertificateType	3
CertificateEffectiveDate	8/12/2023
CertificateExpirationDate	8/11/2025
FacilityType	PPMP

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