38D2124889 CLIA NUMBER - CLINIC FOR DERMATOLOGY & WELLNESS LLC, THE

Laboratory Demographics

CLIA Number: 38D2124889

Facility Name: CLINIC FOR DERMATOLOGY & WELLNESS LLC, THE

Facility Address:
2924 SISKIYOU BLVD SUITE 200
MEDFORD, OR
ZIP 97504
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Facility Phone Number: 541 200-2777

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1467908863

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	38D2124889
LAB Type	Physician Office
Facility Name	CLINIC FOR DERMATOLOGY & WELLNESS LLC, THE
Street	2924 SISKIYOU BLVD SUITE 200
City	MEDFORD
State	OR
ZIP	97504
Phone	541 200-2777
CertificateType	2
CertificateEffectiveDate	1/7/2024
CertificateExpirationDate	1/6/2026
FacilityType	Compliance

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