05D2159459 CLIA NUMBER - NEWPORT ACADEMY MAOLI

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CLIA Record

Field Name Field Value
CLIA Number 05D2159459
LAB Type Practitioner Other
Facility Name NEWPORT ACADEMY MAOLI
Street 1605 LUCAS VALLEY RD
City SAN RAFAEL
State CA
ZIP 94903
Phone 714 393-3523
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2024
Certificate Expiration Date 12/18/2026
Facility Type Practitioner Other
Lab Director DANA FUTORAN

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