05D1031587 CLIA NUMBER - GOLDEN STATE DERMATOLOGY ASSOCIATES, INC FAIR OAKS

Laboratory Demographics

  • CLIA Code: 05D1031587
  • Facility Name: GOLDEN STATE DERMATOLOGY ASSOCIATES, INC FAIR OAKS
  • Facility Address: 2625 FAIR OAKS BLVD STE 1
    SACRAMENTO, CA
    ZIP 95864
  • Facility Phone: 916 646-3376
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: ALISON A. BOUDREAUX MD
  • NPI Number: 1871561589
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 05D1031587
LAB Type Physician Office
Facility Name GOLDEN STATE DERMATOLOGY ASSOCIATES, INC FAIR OAKS
Street 2625 FAIR OAKS BLVD STE 1
City SACRAMENTO
State CA
ZIP 95864
Phone 916 646-3376
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 1/17/2024
Certificate Expiration Date 1/16/2026
Facility Type Physician Office
Lab Director ALISON A. BOUDREAUX MD

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