45D2109149 CLIA NUMBER - WESTLAKE DERMATOLOGY & COSMETIC SURGERY

Laboratory Demographics

  • CLIA Code: 45D2109149
  • Facility Name: WESTLAKE DERMATOLOGY & COSMETIC SURGERY
  • Facility Address: 5301 DAVIS LANE BLDG A STE 100
    AUSTIN, TX
    ZIP 78749
  • Facility Phone: 512 615-3158
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER ROSE GORDON
  • NPI Number: 1356103758
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2109149
LAB Type Physician Office
Facility Name WESTLAKE DERMATOLOGY & COSMETIC SURGERY
Street 5301 DAVIS LANE BLDG A STE 100
City AUSTIN
State TX
ZIP 78749
Phone 512 615-3158
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2025
Certificate Expiration Date 9/20/2027
Facility Type Physician Office
Lab Director JENNIFER ROSE GORDON

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