38D2147625 CLIA NUMBER - DERMATOLOGY BY DESIGN

Laboratory Demographics

  • CLIA Code: 38D2147625
  • Facility Name: DERMATOLOGY BY DESIGN
  • Facility Address: 1129 NW 11TH AVENUE
    PORTLAND, OR
    ZIP 97209
  • Facility Phone: 503 227-3640
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: OMAR N. QUTUB MD
  • NPI Number: 1972004455
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 38D2147625
LAB Type Physician Office
Facility Name DERMATOLOGY BY DESIGN
Street 1129 NW 11TH AVENUE
City PORTLAND
State OR
ZIP 97209
Phone 503 227-3640
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/23/2024
Certificate Expiration Date 4/22/2026
Facility Type Physician Office
Lab Director OMAR N. QUTUB MD

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