CLIA lab
CLIA 05D2333831: Providence Medical Foundation
Petaluma, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D2333831 belongs to Providence Medical Foundation in Petaluma, CA.
Certificate of Waiver, effective November 12, 2025, expires November 11, 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
- November 12, 2025
- Certificate expiration
- November 11, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- November 12, 2025
- 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
- 05D2333831
- Lab name
- Providence Medical Foundation
- Address
- 108 Lynch Creen Dr Ste 3, Petaluma, CA 94952
- Phone
- (707) 303-8323
- Fax
- (707) 525-1033
Annual test volume the lab reported
- Waived tests
- 1,200
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- Accentcare Home Health of CaCertificate of Waiver, Home health agency05D2010775
- Attenda Medical GroupCertificate of Waiver, Physician office05D2169114
- Bridge Home Health East Bay LLCCertificate of Waiver, Home health agency05D2159896
- Continuum Care Hospice, LLCCertificate of Waiver, Hospice05D2155281
- David Chappell MD Medical CorporationCertificate of Waiver, Physician office05D0947611
- Dermatology Associates of the Bay AreaCertificate of Compliance, Physician office05D0691718
- Institute for Health Management, IncCertificate of Waiver, Physician office05D0868551
- Longhorn Ridge RecoveryCertificate of Waiver, Other05D2336124
- Muir Wood Adolescent and Family ServicesCertificate of Waiver, Other05D2089303
- Muir Wood Adolescent and Family ServicesCertificate of Waiver, Ancillary test site05D2320127
Related
Questions
What is the CLIA number for Providence Medical Foundation in Petaluma?
05D2333831, 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 05D2333831 expire?
The CMS file lists November 11, 2027 as the certificate expiration date; the certificate took effect November 12, 2025.