05D2279767 CLIA NUMBER - CARBON HEALTH MEDICAL GROUP OF CA, P.C. DBA CARBON HEALTH

Laboratory Demographics

CLIA Number: 05D2279767

Facility Name: CARBON HEALTH MEDICAL GROUP OF CA, P.C. DBA CARBON HEALTH

Facility Address:
377 SANTANA ROW SUITE 1180
SAN JOSE, CA
ZIP 95128
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Facility Phone Number: 669 247-4773

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740990597

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2279767
LAB Type	Physician Office
Facility Name	CARBON HEALTH MEDICAL GROUP OF CA, P.C. DBA CARBON HEALTH
Street	377 SANTANA ROW SUITE 1180
City	SAN JOSE
State	CA
ZIP	95128
Phone	669 247-4773
CertificateType	4
CertificateEffectiveDate	4/6/2023
CertificateExpirationDate	4/5/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024