05D1057444 CLIA NUMBER - DCI - FORT BRAGG

Laboratory Demographics

  • CLIA Code: 05D1057444
  • Facility Name: DCI - FORT BRAGG
  • Facility Address: 512 CYPRESS ST
    FORT BRAGG, CA
    ZIP 95437
  • Facility Phone: 707 964-1610
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SANDRA BARROW
  • NPI Number: 1497879274
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 05D1057444
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name DCI - FORT BRAGG
Street 512 CYPRESS ST
City FORT BRAGG
State CA
ZIP 95437
Phone 707 964-1610
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2024
Certificate Expiration Date 8/10/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SANDRA BARROW

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