05D2280705 CLIA NUMBER - THE JACKSON LABORATORY ONSITE

Laboratory Demographics

  • CLIA Code: 05D2280705
  • Facility Name: THE JACKSON LABORATORY ONSITE
  • Facility Address: 1650 SANTA ANA AVE
    SACRAMENTO, CA
    ZIP 95838
  • Facility Phone: 207 288-6000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL TENISON
  • NPI Number: 1609205483
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 05D2280705
LAB Type Physician Office
Facility Name THE JACKSON LABORATORY ONSITE
Street 1650 SANTA ANA AVE
City SACRAMENTO
State CA
ZIP 95838
Phone 207 288-6000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2025
Certificate Expiration Date 4/24/2027
Facility Type Physician Office
Lab Director MICHAEL TENISON

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