05D2311025 CLIA NUMBER - SUTTER BAY MEDICAL FOUNDATION-BLOSSOM HILL DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 05D2311025
  • Facility Name: SUTTER BAY MEDICAL FOUNDATION-BLOSSOM HILL DERMATOLOGY
  • Facility Address: 1071 BLOSSOM HILL RD
    SAN JOSE, CA
    ZIP 95123
  • Facility Phone: 408 730-6130
  • Facility Type: Other - MOHS LAB
  • Facility Type: Certificate of Compliance
  • Lab Director: FUAD ABUABARA
  • NPI Number: 1538942842
  • Taxonomy: 261QA1903X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D2311025
LAB Type Other - MOHS LAB
Facility Name SUTTER BAY MEDICAL FOUNDATION-BLOSSOM HILL DERMATOLOGY
Street 1071 BLOSSOM HILL RD
City SAN JOSE
State CA
ZIP 95123
Phone 408 730-6130
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 9/16/2024
Certificate Expiration Date 9/15/2026
Facility Type Other - MOHS LAB
Lab Director FUAD ABUABARA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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