05D2022761 CLIA NUMBER - ROOTS COMMUNITY HEALTH CENTER

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Laboratory Demographics

CLIA Number: 05D2022761

Facility Name: ROOTS COMMUNITY HEALTH CENTER

Facility Address:
9925 INTERNATIONAL BLVD STE 5
OAKLAND, CA
ZIP 94603
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Facility Phone Number: 510 777-1177

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1932663853

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2022761
LAB Type	Community Clinic
Facility Name	ROOTS COMMUNITY HEALTH CENTER
Street	9925 INTERNATIONAL BLVD STE 5
City	OAKLAND
State	CA
ZIP	94603
Phone	510 777-1177
CertificateType	4
CertificateEffectiveDate	4/8/2023
CertificateExpirationDate	4/7/2025
FacilityType	Waiver

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