05D2197443 CLIA NUMBER - CRUZMEDMO

Laboratory Demographics

  • CLIA Code: 05D2197443
  • Facility Name: CRUZMEDMO
  • Facility Address: 626 FREDERICK ST, STE H
    SANTA CRUZ, CA
    ZIP 95062
  • Facility Phone: 831 239-4331
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ANDREW H. LEWIS
  • NPI Number: 1396416152
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 05D2197443
LAB Type Practitioner Other
Facility Name CRUZMEDMO
Street 626 FREDERICK ST, STE H
City SANTA CRUZ
State CA
ZIP 95062
Phone 831 239-4331
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2024
Certificate Expiration Date 10/24/2026
Facility Type Practitioner Other
Lab Director ANDREW H. LEWIS

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