05D2017138 CLIA NUMBER - CLEARLAKE VA CBOC

Laboratory Demographics

  • CLIA Code: 05D2017138
  • Facility Name: CLEARLAKE VA CBOC
  • Facility Address: 15145 LAKESHORE DRIVE
    CLEARLAKE, CA
    ZIP 95422
  • Facility Phone: 707 995-7200
  • Facility Type: Community Clinic
  • Facility Type: Accreditation
  • Lab Director: TIFFANY CHAMBERS
  • NPI Number: 1477502912
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 05D2017138
LAB Type Community Clinic
Facility Name CLEARLAKE VA CBOC
Street 15145 LAKESHORE DRIVE
City CLEARLAKE
State CA
ZIP 95422
Phone 707 995-7200
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 12/6/2010
Certificate Expiration Date 5/22/2026
Facility Type Community Clinic
Lab Director TIFFANY CHAMBERS

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