CLIA lab
CLIA 05D0684180: Portola Medical Clinic
Portola, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D0684180 belongs to Portola Medical Clinic in Portola, CA.
Certificate of Waiver, effective March 9, 2026, expires March 8, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- March 9, 2026
- Certificate expiration
- March 8, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- March 24, 1994
- Facility type
- Rural health clinic
- Ownership (control type)
- Other
- Lab classification
- CLIA laboratory
- Directly affiliated labs
- 2
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 05D0684180
- Lab name
- Portola Medical Clinic
- Address
- 480 1st Ave, Portola, CA 96122
- Phone
- (530) 832-6604
- Fax
- (560) 832-5968
Annual test volume the lab reported
- Waived tests
- 1,900
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Affiliated CLIA numbers
Other labs in Portola, CA
Related
Questions
What is the CLIA number for Portola Medical Clinic in Portola?
05D0684180, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Portola Medical Clinic hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D0684180 expire?
The CMS file lists March 8, 2028 as the certificate expiration date; the certificate took effect March 9, 2026.