05D2124212 CLIA NUMBER - EVERGREEN SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 05D2124212
  • Facility Name: EVERGREEN SURGERY CENTER
  • Facility Address: 2365 QUIMBY RD STE 180
    SAN JOSE, CA
    ZIP 95122
  • Facility Phone: 408 620-5675
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: STEVEN JOHNSON, MD
  • NPI Number: 1538618368
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2124212
LAB Type Ambulatory Surgery Center
Facility Name EVERGREEN SURGERY CENTER
Street 2365 QUIMBY RD STE 180
City SAN JOSE
State CA
ZIP 95122
Phone 408 620-5675
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2025
Certificate Expiration Date 1/10/2027
Facility Type Ambulatory Surgery Center
Lab Director STEVEN JOHNSON, MD

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