05D2071350 CLIA NUMBER - LAKE MERRITT FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 05D2071350
  • Facility Name: LAKE MERRITT FAMILY PRACTICE
  • Facility Address: 450 PARK ST STE 100B
    ALAMEDA, CA
    ZIP 94501
  • Facility Phone: 510 992-3104
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: APRIL L. FREDIAN, MD
  • NPI Number: 1336643303
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2071350
LAB Type Physician Office
Facility Name LAKE MERRITT FAMILY PRACTICE
Street 450 PARK ST STE 100B
City ALAMEDA
State CA
ZIP 94501
Phone 510 992-3104
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/10/2024
Certificate Expiration Date 1/9/2026
Facility Type Physician Office
Lab Director APRIL L. FREDIAN, MD

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