05D2172281 CLIA NUMBER - PENINSULA OBGYN INTEGRATIVE

Laboratory Demographics

  • CLIA Code: 05D2172281
  • Facility Name: PENINSULA OBGYN INTEGRATIVE
  • Facility Address: 101 SOUTH SAN MATEO DRIVE SUITE 111
    SAN MATEO, CA
    ZIP 94401
  • Facility Phone: 650 542-0092
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SAMUEL YOUNG
  • NPI Number: 1669957114
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 05D2172281
LAB Type Physician Office
Facility Name PENINSULA OBGYN INTEGRATIVE
Street 101 SOUTH SAN MATEO DRIVE SUITE 111
City SAN MATEO
State CA
ZIP 94401
Phone 650 542-0092
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 9/18/2025
Certificate Expiration Date 9/17/2027
Facility Type Physician Office
Lab Director SAMUEL YOUNG

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