CLIA lab
CLIA 05D2084325: Providence Medical Foundation
Sebastopol, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D2084325 belongs to Providence Medical Foundation in Sebastopol, CA.
Certificate of Waiver, effective August 1, 2025, expires July 31, 2027.
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
- August 1, 2025
- Certificate expiration
- July 31, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- September 22, 2014
- Facility type
- Physician office
- Ownership (control type)
- Religious affiliation
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 05D2084325
- Lab name
- Providence Medical Foundation
- Additional name
- Sebastopol Family Practice
- Address
- 652 Petaluma Ave Ste B, Sebastopol, CA 95472
- Phone
- (707) 823-7616
- Fax
- (707) 823-2803
Annual test volume the lab reported
- Waived tests
- 300
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Sebastopol, CA
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- Bohemian Concierge Care IncCertificate of Waiver, Physician office05D2244713
- DRS Pitzen & AndersenCertificate for Provider-Performed Microscopy Procedures, Physician office05D0692031
- Eye Associates of SebastopolCertificate of Compliance, Physician office05D1077728
- Safeway Pharmacy #0933Certificate of Waiver, Pharmacy05D2058069
- Sebastopol Ambulatory Surgery CTR LPCertificate of Waiver, Ambulatory surgery center05D0895558
- Sonoma Specialty HospitalCertificate of Compliance, Hospital05D0612335
Related
Questions
What is the CLIA number for Providence Medical Foundation in Sebastopol?
05D2084325, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Providence Medical Foundation hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D2084325 expire?
The CMS file lists July 31, 2027 as the certificate expiration date; the certificate took effect August 1, 2025.