05D1046400 CLIA NUMBER - LARKIN STREET MEDICAL CLINIC, OA C AND T

Laboratory Demographics

CLIA Number: 05D1046400

Facility Name: LARKIN STREET MEDICAL CLINIC, OA C AND T

Facility Address:
134 GOLDEN GATE AVE
SAN FRANCISCO, CA
ZIP 94102
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Facility Phone Number: 415 673-0911

Facility Type: Other - COMMUNITY BASED ORG

Certificate Type: Waiver

NPI Number: 1356381214

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1046400
LAB Type	Other - COMMUNITY BASED ORG
Facility Name	LARKIN STREET MEDICAL CLINIC, OA C AND T
Street	134 GOLDEN GATE AVE
City	SAN FRANCISCO
State	CA
ZIP	94102
Phone	415 673-0911
CertificateType	4
CertificateEffectiveDate	6/16/2022
CertificateExpirationDate	6/15/2024
FacilityType	Waiver

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