05D2171321 CLIA NUMBER - VASCULAR INSTITUTE OF NORTHERN CALIFORNIA

Laboratory Demographics

CLIA Number: 05D2171321

Facility Name: VASCULAR INSTITUTE OF NORTHERN CALIFORNIA

Facility Address:
500 UNIVERSITY AVENUE SUITE 250
SACRAMENTO, CA
ZIP 95825
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Facility Phone Number: 916 680-9510

Facility Type: Other - OFFICE BASED VASCULAR

Certificate Type: Waiver

NPI Number: 1932691797

Taxonomy: 2086S0129X - Surgery
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

CLIA Record

Field Name	Field Value
CLIA Number	05D2171321
LAB Type	Other - OFFICE BASED VASCULAR
Facility Name	VASCULAR INSTITUTE OF NORTHERN CALIFORNIA
Street	500 UNIVERSITY AVENUE SUITE 250
City	SACRAMENTO
State	CA
ZIP	95825
Phone	916 680-9510
CertificateType	4
CertificateEffectiveDate	8/28/2023
CertificateExpirationDate	8/27/2025
FacilityType	Waiver

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