05D2007926 CLIA NUMBER - TEODORO P NISSEN MD INC BAY AREA ORTHORPEDIC SURGERY AND SPORTS MEDICINE

Laboratory Demographics

  • CLIA Code: 05D2007926
  • Facility Name: TEODORO P NISSEN MD INC BAY AREA ORTHORPEDIC SURGERY AND SPORTS MEDICINE
  • Facility Address: 100 HOSPITAL DRIVE # 303
    VALLEJO, CA
    ZIP 94589
  • Facility Phone: 707 645-7210
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TEODORO P. NISSEN
  • NPI Number: 1699791053
  • Taxonomy: 207X00000X - Orthopaedic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 05D2007926
LAB Type Physician Office
Facility Name TEODORO P NISSEN MD INC BAY AREA ORTHORPEDIC SURGERY AND SPORTS MEDICINE
Street 100 HOSPITAL DRIVE # 303
City VALLEJO
State CA
ZIP 94589
Phone 707 645-7210
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2024
Certificate Expiration Date 8/17/2026
Facility Type Physician Office
Lab Director TEODORO P. NISSEN

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