05D2297507 CLIA NUMBER - PROSALUD FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 05D2297507

Facility Name: PROSALUD FAMILY MEDICINE

Facility Address:
2480 MISSION STREET SUITE 221
SAN FRANCISCO, CA
ZIP 94110
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Facility Phone Number: 628 223-5395

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1467109793

Taxonomy: 207QA0505X - Family Medicine
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

CLIA Record

Field Name	Field Value
CLIA Number	05D2297507
LAB Type	Physician Office
Facility Name	PROSALUD FAMILY MEDICINE
Street	2480 MISSION STREET SUITE 221
City	SAN FRANCISCO
State	CA
ZIP	94110
Phone	628 223-5395
CertificateType	4
CertificateEffectiveDate	1/17/2024
CertificateExpirationDate	1/16/2026
FacilityType	Waiver

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