05D2188725 CLIA NUMBER - DALE EKSTRUM MD INC

Laboratory Demographics

  • CLIA Code: 05D2188725
  • Facility Name: DALE EKSTRUM MD INC
  • Facility Address: 217 WEST CENTRAL AVE STE A
    LOMPOC, CA
    ZIP 93436
  • Facility Phone: 805 735-4999
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DALE E. EKSTRUM
  • NPI Number: 1316133358
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2188725
LAB Type Physician Office
Facility Name DALE EKSTRUM MD INC
Street 217 WEST CENTRAL AVE STE A
City LOMPOC
State CA
ZIP 93436
Phone 805 735-4999
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 7/21/2024
Certificate Expiration Date 7/20/2026
Facility Type Physician Office
Lab Director DALE E. EKSTRUM

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