05D2019222 CLIA NUMBER - CONCENTRA - SANTA ROSA

Laboratory Demographics

  • CLIA Code: 05D2019222
  • Facility Name: CONCENTRA - SANTA ROSA
  • Facility Address: 1221 N DUTTON AVE
    SANTA ROSA, CA
    ZIP 95401
  • Facility Phone: 707 543-8360
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAISHRI RAMESH
  • NPI Number: 1346499415
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2019222
LAB Type Physician Office
Facility Name CONCENTRA - SANTA ROSA
Street 1221 N DUTTON AVE
City SANTA ROSA
State CA
ZIP 95401
Phone 707 543-8360
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Physician Office
Lab Director JAISHRI RAMESH

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