05D1097391 CLIA NUMBER - DAVID M TULLY-SMITH, MD, A MEDICAL CORPORATION DBA MILL VALLEY MEDICAL

Laboratory Demographics

  • CLIA Code: 05D1097391
  • Facility Name: DAVID M TULLY-SMITH, MD, A MEDICAL CORPORATION DBA MILL VALLEY MEDICAL
  • Facility Address: 711 D STREET, SUITE 111
    SAN RAFAEL, CA
    ZIP 94901
  • Facility Phone: 415 453-3030
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID M. TULLY-SMITH, MD
  • NPI Number: 1598890287
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1097391
LAB Type Physician Office
Facility Name DAVID M TULLY-SMITH, MD, A MEDICAL CORPORATION DBA MILL VALLEY MEDICAL
Street 711 D STREET, SUITE 111
City SAN RAFAEL
State CA
ZIP 94901
Phone 415 453-3030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Physician Office
Lab Director DAVID M. TULLY-SMITH, MD

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