38D2242812 CLIA NUMBER - DR AOB CLINIC LLC

Laboratory Demographics

  • CLIA Code: 38D2242812
  • Facility Name: DR AOB CLINIC LLC
  • Facility Address: 2540A NE MARTIN LUTHER KING BLVD
    PORTLAND, OR
    ZIP 97212
  • Facility Phone: 971 220-2759
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AIMEE O. BONNEVAL
  • NPI Number: 1023695830
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D2242812
LAB Type Physician Office
Facility Name DR AOB CLINIC LLC
Street 2540A NE MARTIN LUTHER KING BLVD
City PORTLAND
State OR
ZIP 97212
Phone 971 220-2759
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2023
Certificate Expiration Date 11/11/2025
Facility Type Physician Office
Lab Director AIMEE O. BONNEVAL

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