13D2273503 CLIA NUMBER - TREASURE VALLEY DERMATOLOGY & SKIN CANCER CENTER

Laboratory Demographics

  • CLIA Code: 13D2273503
  • Facility Name: TREASURE VALLEY DERMATOLOGY & SKIN CANCER CENTER
  • Facility Address: 404 E ELM STREET
    CALDWELL, ID
    ZIP 83605
  • Facility Phone: (208) 519-4333
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DUSTIN R. PORTELA
  • NPI Number: 1598271645
  • Taxonomy: 207N00000X - Dermatology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 13D2273503
LAB Type Physician Office
Facility Name TREASURE VALLEY DERMATOLOGY & SKIN CANCER CENTER
Street 404 E ELM STREET
City CALDWELL
State ID
ZIP 83605
Phone 2085194333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/14/2024
Certificate Expiration Date 12/13/2026
Facility Type Physician Office
Lab Director DUSTIN R. PORTELA

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: 5/18/2026