05D0921212 CLIA NUMBER - CLINICA ALTA VISTA

Laboratory Demographics

CLIA Number: 05D0921212

Facility Name: CLINICA ALTA VISTA

Facility Address:
1515 FRUITVALE AVE
OAKLAND, CA
ZIP 94601
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Facility Phone Number: 510 535-6300

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1235245275

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0921212
LAB Type	Federally Qualified Health Center
Facility Name	CLINICA ALTA VISTA
Street	1515 FRUITVALE AVE
City	OAKLAND
State	CA
ZIP	94601
Phone	510 535-6300
CertificateType	3
CertificateEffectiveDate	10/22/2022
CertificateExpirationDate	10/21/2024
FacilityType	PPMP

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