05D1007177 CLIA NUMBER - PALO ALTO MEDICAL FOUNDATION - PALTO ALTO CENTER

Laboratory Demographics

  • CLIA Code: 05D1007177
  • Facility Name: PALO ALTO MEDICAL FOUNDATION - PALTO ALTO CENTER
  • Facility Address: 795 EL CAMINO REAL LEE, JAMPLIS, AND CLARK BLDG
    PALO ALTO, CA
    ZIP 94301
  • Facility Phone: 650 853-2679
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Microscopy
  • Lab Director: DR. IRENA ILIC
  • NPI Number: 1013399989
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1007177
LAB Type Ancillary Testing Site in Health Care Center
Facility Name PALO ALTO MEDICAL FOUNDATION - PALTO ALTO CENTER
Street 795 EL CAMINO REAL LEE, JAMPLIS, AND CLARK BLDG
City PALO ALTO
State CA
ZIP 94301
Phone 650 853-2679
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 12/10/2024
Certificate Expiration Date 12/9/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director DR. IRENA ILIC

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