05D2100866 CLIA NUMBER - EVERGREEN URGENT CARE CENTER

Laboratory Demographics

CLIA Number: 05D2100866

Facility Name: EVERGREEN URGENT CARE CENTER

Facility Address:
2365 QUIMBY RD STE 160
SAN JOSE, CA
ZIP 95122
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Facility Phone Number: 408 550-2750

Facility Type: Other - URGENT CARE CENTER

Certificate Type: Waiver

NPI Number: 1487048963

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2100866
LAB Type	Other - URGENT CARE CENTER
Facility Name	EVERGREEN URGENT CARE CENTER
Street	2365 QUIMBY RD STE 160
City	SAN JOSE
State	CA
ZIP	95122
Phone	408 550-2750
CertificateType	4
CertificateEffectiveDate	5/21/2022
CertificateExpirationDate	5/20/2024
FacilityType	Waiver

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