05D2274376 CLIA NUMBER - NEWPORT ACADEMY - AUTUMN

Laboratory Demographics

  • CLIA Code: 05D2274376
  • Facility Name: NEWPORT ACADEMY - AUTUMN
  • Facility Address: 1785 AUTUMN LANE
    SHINGLE SPRINGS, CA
    ZIP 95682
  • Facility Phone: 714 393-3523
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DR. DANIEL M. GORDON
  • NPI Number: 1689275620
  • Taxonomy: 323P00000X - Psychiatric Residential Treatment Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2274376
LAB Type Practitioner Other
Facility Name NEWPORT ACADEMY - AUTUMN
Street 1785 AUTUMN LANE
City SHINGLE SPRINGS
State CA
ZIP 95682
Phone 714 393-3523
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2025
Certificate Expiration Date 1/2/2027
Facility Type Practitioner Other
Lab Director DR. DANIEL M. GORDON

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