05D2002532 CLIA NUMBER - LYNNE MIELKE MD

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Laboratory Demographics

CLIA Number: 05D2002532

Facility Name: LYNNE MIELKE MD

Facility Address:
4463 STONERIDGE DR STE A
PLEASANTON, CA
ZIP 94588
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Facility Phone Number: 925 846-6300

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700985413

Taxonomy: 2084P0005X - Psychiatry & Neurology
A neurologist who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina bifida, autism, and other chronic neurologic conditions.

CLIA Record

Field Name	Field Value
CLIA Number	05D2002532
LAB Type	Physician Office
Facility Name	LYNNE MIELKE MD
Street	4463 STONERIDGE DR STE A
City	PLEASANTON
State	CA
ZIP	94588
Phone	925 846-6300
CertificateType	4
CertificateEffectiveDate	1/20/2024
CertificateExpirationDate	1/19/2026
FacilityType	Waiver

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