05D2284677 CLIA NUMBER - CARBON HEALTH SOUTH BAY MEDICAL GROUP PC

Laboratory Demographics

CLIA Number: 05D2284677

Facility Name: CARBON HEALTH SOUTH BAY MEDICAL GROUP PC

Facility Address:
2580 W. EL CAMINO REAL
MOUNTAIN VIEW, CA
ZIP 94040
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Facility Phone Number: 650 540-8851

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1871035048

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2284677
LAB Type	Physician Office
Facility Name	CARBON HEALTH SOUTH BAY MEDICAL GROUP PC
Street	2580 W. EL CAMINO REAL
City	MOUNTAIN VIEW
State	CA
ZIP	94040
Phone	650 540-8851
CertificateType	4
CertificateEffectiveDate	6/27/2023
CertificateExpirationDate	6/26/2025
FacilityType	Waiver

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