50D2092816 CLIA NUMBER - PROLIANCE SURGICAL SPECIALISTS AT OVERLAKE

Laboratory Demographics

  • CLIA Code: 50D2092816
  • Facility Name: PROLIANCE SURGICAL SPECIALISTS AT OVERLAKE
  • Facility Address: 1231 116TH AVE NE STE 535
    BELLEVUE, WA
    ZIP 98004
  • Facility Phone: 425 688-1916
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MITRA EHSAN
  • NPI Number: 1306434691
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 50D2092816
LAB Type Physician Office
Facility Name PROLIANCE SURGICAL SPECIALISTS AT OVERLAKE
Street 1231 116TH AVE NE STE 535
City BELLEVUE
State WA
ZIP 98004
Phone 425 688-1916
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/13/2015
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director MITRA EHSAN

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