38D2177050 CLIA NUMBER - PROVIDENCE EXPRESSCARE CRESTON

Laboratory Demographics

  • CLIA Code: 38D2177050
  • Facility Name: PROVIDENCE EXPRESSCARE CRESTON
  • Facility Address: 3822 SE POWELL BLVD
    PORTLAND, OR
    ZIP 97202
  • Facility Phone: 888 227-3312
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARINA SARWARY
  • NPI Number: 1770244568
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D2177050
LAB Type Physician Office
Facility Name PROVIDENCE EXPRESSCARE CRESTON
Street 3822 SE POWELL BLVD
City PORTLAND
State OR
ZIP 97202
Phone 888 227-3312
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/2/2024
Certificate Expiration Date 1/1/2026
Facility Type Physician Office
Lab Director MARINA SARWARY

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