05D2176822 CLIA NUMBER - SUTTER PACIFIC MEDICAL FOUNDATION

Laboratory Demographics

  • CLIA Code: 05D2176822
  • Facility Name: SUTTER PACIFIC MEDICAL FOUNDATION
  • Facility Address: 3883 AIRWAY DRIVE SUITE 320
    SANTA ROSA, CA
    ZIP 95403
  • Facility Phone: 707 523-7220
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ZEYAD KANAAN
  • NPI Number: 1528512688
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2176822
LAB Type Physician Office
Facility Name SUTTER PACIFIC MEDICAL FOUNDATION
Street 3883 AIRWAY DRIVE SUITE 320
City SANTA ROSA
State CA
ZIP 95403
Phone 707 523-7220
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 12/26/2023
Certificate Expiration Date 12/25/2025
Facility Type Physician Office
Lab Director ZEYAD KANAAN

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