05D2105807 CLIA NUMBER - SAN RAFAEL DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2105807
  • Facility Name: SAN RAFAEL DIALYSIS
  • Facility Address: 1415 3RD ST
    SAN RAFAEL, CA
    ZIP 94901
  • Facility Phone: 415 453-4437
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SARA HOLMES
  • NPI Number: 1023499605
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2105807
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name SAN RAFAEL DIALYSIS
Street 1415 3RD ST
City SAN RAFAEL
State CA
ZIP 94901
Phone 415 453-4437
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2023
Certificate Expiration Date 12/2/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SARA HOLMES

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This page was last updated on: 6/4/2025