CLIA lab
CLIA 05D2124806: Clark Plastic Surgery DBA Granite Bay
Granite Bay, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D2124806 belongs to Clark Plastic Surgery DBA Granite Bay in Granite Bay, CA.
Certificate of Waiver, effective January 25, 2025, expires January 24, 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
- January 25, 2025
- Certificate expiration
- January 24, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- January 25, 2017
- Facility type
- Ambulatory surgery center
- Ownership (control type)
- Proprietary
- 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
- 05D2124806
- Lab name
- Clark Plastic Surgery DBA Granite Bay
- Additional name
- Cosmetic Surgery
- Address
- 5220 Douglas Blvd, Granite Bay, CA 95746
- Phone
- (916) 242-2662
- Fax
- (916) 242-4165
Annual test volume the lab reported
- Waived tests
- 1,000
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Granite Bay, CA
- Caremeridian - Granite BayCertificate of Waiver, Other05D1088955
- Center for Discovery, SacramentoCertificate of Waiver, Other05D2098057
- Discovery Practice ManagementCertificate of Waiver, Other05D2275579
- Eric L. Ellis MD, Inc.Certificate of Accreditation, Physician office05D2263079
- Orisek and Mccaskill Medical Group IncCertificate of Registration, Physician office05D2312128
- Walgreens #06036Certificate of Waiver, Pharmacy05D2259226
Related
Questions
What is the CLIA number for Clark Plastic Surgery DBA Granite Bay in Granite Bay?
05D2124806, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Clark Plastic Surgery DBA Granite Bay hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D2124806 expire?
The CMS file lists January 24, 2027 as the certificate expiration date; the certificate took effect January 25, 2025.