46D0936315 CLIA NUMBER - MATIS DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 46D0936315
  • Facility Name: MATIS DERMATOLOGY
  • Facility Address: 710 EAST 200 SOUTH #1B
    SALT LAKE CITY, UT
    ZIP 84102
  • Facility Phone: 801 521-0100
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: WENDY L. MATIS
  • NPI Number: 1790016434
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 46D0936315
LAB Type Physician Office
Facility Name MATIS DERMATOLOGY
Street 710 EAST 200 SOUTH #1B
City SALT LAKE CITY
State UT
ZIP 84102
Phone 801 521-0100
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 4/2/2024
Certificate Expiration Date 4/1/2026
Facility Type Physician Office
Lab Director WENDY L. MATIS

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