50D0640256 CLIA NUMBER - WALLA WALLA CLINIC

Laboratory Demographics

  • CLIA Code: 50D0640256
  • Facility Name: WALLA WALLA CLINIC
  • Facility Address: 55 W TIETAN ST
    WALLA WALLA, WA
    ZIP 99362
  • Facility Phone: 509 525-3720
  • Facility Type: Other - CLINIC
  • Facility Type: Waiver
  • Lab Director: RYAN CORNIA
  • NPI Number: 1063521862
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D0640256
LAB Type Other - CLINIC
Facility Name WALLA WALLA CLINIC
Street 55 W TIETAN ST
City WALLA WALLA
State WA
ZIP 99362
Phone 509 525-3720
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2023
Certificate Expiration Date 4/4/2028
Facility Type Other - CLINIC
Lab Director RYAN CORNIA

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