05D1059696 CLIA NUMBER - EVERGREEN PEDIATRIC ASSOCIATES, INC

Laboratory Demographics

  • CLIA Code: 05D1059696
  • Facility Name: EVERGREEN PEDIATRIC ASSOCIATES, INC
  • Facility Address: 1569 LEXANNAVE STE 232
    SAN JOSE, CA
    ZIP 95121
  • Facility Phone: 408 270-3374
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LINDA M. HA
  • NPI Number: 1215960455
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D1059696
LAB Type Physician Office
Facility Name EVERGREEN PEDIATRIC ASSOCIATES, INC
Street 1569 LEXANNAVE STE 232
City SAN JOSE
State CA
ZIP 95121
Phone 408 270-3374
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2024
Certificate Expiration Date 10/3/2026
Facility Type Physician Office
Lab Director LINDA M. HA

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