05D1090124 CLIA NUMBER - ADVENTIST HEALTH MEDICAL SPECIALTY

Laboratory Demographics

  • CLIA Code: 05D1090124
  • Facility Name: ADVENTIST HEALTH MEDICAL SPECIALTY
  • Facility Address: 18990 COYOTE VALLEY ROAD STE 10
    HIDDEN VALLEY LAKE, CA
    ZIP 95467
  • Facility Phone: 707 995-5805
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: COREY M. WARNER MD
  • NPI Number: 1528308004
  • Taxonomy: 2081P2900X - Physical Medicine & Rehabilitation

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CLIA Record

Field Name Field Value
CLIA Number 05D1090124
LAB Type Rural Health Clinic
Facility Name ADVENTIST HEALTH MEDICAL SPECIALTY
Street 18990 COYOTE VALLEY ROAD STE 10
City HIDDEN VALLEY LAKE
State CA
ZIP 95467
Phone 707 995-5805
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/2/2024
Certificate Expiration Date 10/1/2026
Facility Type Rural Health Clinic
Lab Director COREY M. WARNER MD

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