05D1065626 CLIA NUMBER - EVERGREEN VALLEY COLLEGE STUDENT HEALTH SERVICES

Laboratory Demographics

CLIA Number: 05D1065626

Facility Name: EVERGREEN VALLEY COLLEGE STUDENT HEALTH SERVICES

Facility Address:
3095 YERBA BUENA RD STE SC-124
SAN JOSE, CA
ZIP 95135
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Facility Phone Number: 408 270-6480

Facility Type: School/Student Health Service

Certificate Type: Microscopy

NPI Number: 1497975882

Taxonomy: 261QS1000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1065626
LAB Type	School/Student Health Service
Facility Name	EVERGREEN VALLEY COLLEGE STUDENT HEALTH SERVICES
Street	3095 YERBA BUENA RD STE SC-124
City	SAN JOSE
State	CA
ZIP	95135
Phone	408 270-6480
CertificateType	3
CertificateEffectiveDate	3/6/2023
CertificateExpirationDate	3/5/2025
FacilityType	PPMP

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