13D2143283 CLIA NUMBER - EAGLE DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 13D2143283
  • Facility Name: EAGLE DERMATOLOGY
  • Facility Address: 74 N FISHER PARKWAY
    EAGLE, ID
    ZIP 83616
  • Facility Phone: 208 391-7210
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: GABRIEL G. GUERRERO
  • NPI Number: 1417456385
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 13D2143283
LAB Type Physician Office
Facility Name EAGLE DERMATOLOGY
Street 74 N FISHER PARKWAY
City EAGLE
State ID
ZIP 83616
Phone 208 391-7210
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 3/12/2025
Certificate Expiration Date 3/11/2027
Facility Type Physician Office
Lab Director GABRIEL G. GUERRERO

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