05D2241857 CLIA NUMBER - AVERY LANE, LLC

Laboratory Demographics

  • CLIA Code: 05D2241857
  • Facility Name: AVERY LANE, LLC
  • Facility Address: 133 MAESTRO RD
    NOVATO, CA
    ZIP 94947
  • Facility Phone: 415 895-5360
  • Facility Type: Other - RESIDENTIAL REHAB FACILIT
  • Facility Type: Waiver
  • Lab Director: DAVID E. SMITH
  • NPI Number: 1922552496
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2241857
LAB Type Other - RESIDENTIAL REHAB FACILIT
Facility Name AVERY LANE, LLC
Street 133 MAESTRO RD
City NOVATO
State CA
ZIP 94947
Phone 415 895-5360
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Other - RESIDENTIAL REHAB FACILIT
Lab Director DAVID E. SMITH

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