05D2211395 CLIA NUMBER - LIFELONG TRUST STREET MEDICINE MOBILE #1

Laboratory Demographics

  • CLIA Code: 05D2211395
  • Facility Name: LIFELONG TRUST STREET MEDICINE MOBILE #1
  • Facility Address: 2712 ADELINE STREET, SUITE A
    OAKLAND, CA
    ZIP 94607
  • Facility Phone: 510 981-3213
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: MICHAEL STACEY
  • NPI Number: 1023594991
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 05D2211395
LAB Type Federally Qualified Health Center
Facility Name LIFELONG TRUST STREET MEDICINE MOBILE #1
Street 2712 ADELINE STREET, SUITE A
City OAKLAND
State CA
ZIP 94607
Phone 510 981-3213
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/27/2025
Certificate Expiration Date 1/26/2027
Facility Type Federally Qualified Health Center
Lab Director MICHAEL STACEY

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