05D1036771 CLIA NUMBER - CANYON PINOLE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 05D1036771
  • Facility Name: CANYON PINOLE SURGERY CENTER
  • Facility Address: 1700 SAN PABLO AVE, STE D
    PINOLE, CA
    ZIP 94564
  • Facility Phone: 510 724-9500
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SCOTT E. LEE MD
  • NPI Number: 1497791040
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1036771
LAB Type Ambulatory Surgery Center
Facility Name CANYON PINOLE SURGERY CENTER
Street 1700 SAN PABLO AVE, STE D
City PINOLE
State CA
ZIP 94564
Phone 510 724-9500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2025
Certificate Expiration Date 2/8/2027
Facility Type Ambulatory Surgery Center
Lab Director SCOTT E. LEE MD

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