05D1084240 CLIA NUMBER - CALIFORNIA MEDICAL FACILITY

Laboratory Demographics

  • CLIA Code: 05D1084240
  • Facility Name: CALIFORNIA MEDICAL FACILITY
  • Facility Address: 1600 CALIFORNIA DRIVE
    VACAVILLE, CA
    ZIP 95696
  • Facility Phone: 707 453-7006
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: MOHAMEDNOOR OSMAN
  • NPI Number: 1285704098
  • Taxonomy: 284300000X - Special Hospital

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CLIA Record

Field Name Field Value
CLIA Number 05D1084240
LAB Type Prison
Facility Name CALIFORNIA MEDICAL FACILITY
Street 1600 CALIFORNIA DRIVE
City VACAVILLE
State CA
ZIP 95696
Phone 707 453-7006
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Prison
Lab Director MOHAMEDNOOR OSMAN

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