05D2054147 CLIA NUMBER - SUMMIT PAIN ALLIANCE INC

Laboratory Demographics

  • CLIA Code: 05D2054147
  • Facility Name: SUMMIT PAIN ALLIANCE INC
  • Facility Address: 392 TESCONI CT
    SANTA ROSA, CA
    ZIP 95401
  • Facility Phone: 707 623-9803
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: BRADDEN W. JENSEN
  • NPI Number: 1558630020
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 05D2054147
LAB Type Physician Office
Facility Name SUMMIT PAIN ALLIANCE INC
Street 392 TESCONI CT
City SANTA ROSA
State CA
ZIP 95401
Phone 707 623-9803
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 3/23/2024
Certificate Expiration Date 3/22/2026
Facility Type Physician Office
Lab Director BRADDEN W. JENSEN

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