38D0972454 CLIA NUMBER - PROVIDENCE OCCUPATIONAL MEDICINE TANASBOURNE

Laboratory Demographics

  • CLIA Code: 38D0972454
  • Facility Name: PROVIDENCE OCCUPATIONAL MEDICINE TANASBOURNE
  • Facility Address: 10670 NE CORNELL RD, STE 204
    HILLSBORO, OR
    ZIP 97124
  • Facility Phone: 503 216-7960
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WALAA ABDELMOATY
  • NPI Number: 1306174438
  • Taxonomy: 261QX0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D0972454
LAB Type Physician Office
Facility Name PROVIDENCE OCCUPATIONAL MEDICINE TANASBOURNE
Street 10670 NE CORNELL RD, STE 204
City HILLSBORO
State OR
ZIP 97124
Phone 503 216-7960
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2024
Certificate Expiration Date 4/6/2026
Facility Type Physician Office
Lab Director WALAA ABDELMOATY

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