05D2172616 CLIA NUMBER - EVOLVE RESTORATIVE CENTER

Laboratory Demographics

  • CLIA Code: 05D2172616
  • Facility Name: EVOLVE RESTORATIVE CENTER
  • Facility Address: 220 CONCOURSE BLVD
    SANTA ROSA, CA
    ZIP 95403
  • Facility Phone: 844 527-7369
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. KIM JANATPOUR
  • NPI Number: 1215437249
  • Taxonomy: 208VP0014X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2172616
LAB Type Physician Office
Facility Name EVOLVE RESTORATIVE CENTER
Street 220 CONCOURSE BLVD
City SANTA ROSA
State CA
ZIP 95403
Phone 844 527-7369
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 7/15/2024
Certificate Expiration Date 7/14/2026
Facility Type Physician Office
Lab Director DR. KIM JANATPOUR

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