05D2281529 CLIA NUMBER - DIGNITY HEALTH MEDICAL FOUNDATION

Laboratory Demographics

  • CLIA Code: 05D2281529
  • Facility Name: DIGNITY HEALTH MEDICAL FOUNDATION
  • Facility Address: 1595 SOQUEL DR, STE 230
    SANTA CRUZ, CA
    ZIP 95065
  • Facility Phone: 916 379-2861
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. ELLISON
  • NPI Number: 1770794265
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2281529
LAB Type Physician Office
Facility Name DIGNITY HEALTH MEDICAL FOUNDATION
Street 1595 SOQUEL DR, STE 230
City SANTA CRUZ
State CA
ZIP 95065
Phone 916 379-2861
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2025
Certificate Expiration Date 5/8/2027
Facility Type Physician Office
Lab Director MICHAEL J. ELLISON

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