05D2286383 CLIA NUMBER - SUTTER BAY MEDICAL FOUNDATION - 3100 TELEGRAPH

Laboratory Demographics

  • CLIA Code: 05D2286383
  • Facility Name: SUTTER BAY MEDICAL FOUNDATION - 3100 TELEGRAPH
  • Facility Address: 3100 TELEGRAPH AVENUE
    OAKLAND, CA
    ZIP 94609
  • Facility Phone: 925 257-3218
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DEREK JOHNSON
  • NPI Number: 1295181477
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 05D2286383
LAB Type Physician Office
Facility Name SUTTER BAY MEDICAL FOUNDATION - 3100 TELEGRAPH
Street 3100 TELEGRAPH AVENUE
City OAKLAND
State CA
ZIP 94609
Phone 925 257-3218
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/27/2025
Certificate Expiration Date 7/26/2027
Facility Type Physician Office
Lab Director DEREK JOHNSON

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