12D0911714 CLIA NUMBER - KAISER PERMANENTE WAIMEA CLINIC PPMP

Laboratory Demographics

CLIA Number: 12D0911714

Facility Name: KAISER PERMANENTE WAIMEA CLINIC PPMP

Facility Address:
67-1185 MAMALAHOA HIGHWAY
KAMUELA, HI
ZIP 96743
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Facility Phone Number: 808 881-4560

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1205390358

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	12D0911714
LAB Type	Physician Office
Facility Name	KAISER PERMANENTE WAIMEA CLINIC PPMP
Street	67-1185 MAMALAHOA HIGHWAY
City	KAMUELA
State	HI
ZIP	96743
Phone	808 881-4560
CertificateType	3
CertificateEffectiveDate	2/13/2024
CertificateExpirationDate	2/12/2026
FacilityType	PPMP

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