05D2068054 CLIA NUMBER - BLACKHAWK MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 05D2068054
  • Facility Name: BLACKHAWK MEDICAL CLINIC
  • Facility Address: 3424 CAMINO TASSAJARA RD
    DANVILLE, CA
    ZIP 94506
  • Facility Phone: 925 309-2700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHAN B. HUMPHREY
  • NPI Number: 1093398141
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 05D2068054
LAB Type Physician Office
Facility Name BLACKHAWK MEDICAL CLINIC
Street 3424 CAMINO TASSAJARA RD
City DANVILLE
State CA
ZIP 94506
Phone 925 309-2700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Physician Office
Lab Director JONATHAN B. HUMPHREY

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