38D2291267 CLIA NUMBER - LIBERTY BLANK ND LLC

Laboratory Demographics

  • CLIA Code: 38D2291267
  • Facility Name: LIBERTY BLANK ND LLC
  • Facility Address: 12755 SW 69TH AVE, STE 206
    PORTLAND, OR
    ZIP 97223
  • Facility Phone: 503 944-1138
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LIBERTY M. BLANK
  • NPI Number: 1093594392
  • Taxonomy: 202D00000X - Integrative Medicine

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CLIA Record

Field Name Field Value
CLIA Number 38D2291267
LAB Type Physician Office
Facility Name LIBERTY BLANK ND LLC
Street 12755 SW 69TH AVE, STE 206
City PORTLAND
State OR
ZIP 97223
Phone 503 944-1138
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/8/2023
Certificate Expiration Date 10/7/2025
Facility Type Physician Office
Lab Director LIBERTY M. BLANK

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