05D1102244 CLIA NUMBER - SUMMIT HEALTH GROUP

Laboratory Demographics

  • CLIA Code: 05D1102244
  • Facility Name: SUMMIT HEALTH GROUP
  • Facility Address: 55 ROLLING OAKS DR, STE 100
    THOUSAND OAKS, CA
    ZIP 91361
  • Facility Phone: 805 499-4446
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DONNELLY R. WILKES, MD
  • NPI Number: 1497125868
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1102244
LAB Type Physician Office
Facility Name SUMMIT HEALTH GROUP
Street 55 ROLLING OAKS DR, STE 100
City THOUSAND OAKS
State CA
ZIP 91361
Phone 805 499-4446
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2025
Certificate Expiration Date 7/23/2027
Facility Type Physician Office
Lab Director DONNELLY R. WILKES, MD

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