36D0952421 CLIA NUMBER - DAN F BAUTISTA MD

Laboratory Demographics

  • CLIA Code: 36D0952421
  • Facility Name: DAN F BAUTISTA MD
  • Facility Address: 1840 COMMERCE CENTER BOULEVARD
    FAIRBORN, OH
    ZIP 45324
  • Facility Phone: 937 754-4580
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAN F. BAUTISTA MD
  • NPI Number: 1629006903
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D0952421
LAB Type Physician Office
Facility Name DAN F BAUTISTA MD
Street 1840 COMMERCE CENTER BOULEVARD
City FAIRBORN
State OH
ZIP 45324
Phone 937 754-4580
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2025
Certificate Expiration Date 3/2/2027
Facility Type Physician Office
Lab Director DAN F. BAUTISTA MD

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