05D0922388 CLIA NUMBER - DOUGLAS E SEVERANCE MD

Laboratory Demographics

  • CLIA Code: 05D0922388
  • Facility Name: DOUGLAS E SEVERANCE MD
  • Facility Address: 5601 NORRIS CANYON ROAD SUITE 330
    SAN RAMON, CA
    ZIP 94583
  • Facility Phone: 510 275-0400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DOUGLAS E. SEVERANCE MD
  • NPI Number: 1639289838
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0922388
LAB Type Physician Office
Facility Name DOUGLAS E SEVERANCE MD
Street 5601 NORRIS CANYON ROAD SUITE 330
City SAN RAMON
State CA
ZIP 94583
Phone 510 275-0400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2024
Certificate Expiration Date 11/20/2026
Facility Type Physician Office
Lab Director DOUGLAS E. SEVERANCE MD

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This page was last updated on: 6/4/2025