CENTERS FOR MIEDICARE&MEDICAID SERVICES
CLINICAL LABORATORY IMP
ENT AMENDMIENTS
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LABORATORY NAME AND ADDRESS
CORPORA丁 10N
475 BRANNAN S丁
CLIA ID NUMIBER
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05D2040778
SAN FRANC:SCO,CA 94107-1713
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EFFECTIVE DATE
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LABORATORY DIRECTOR
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26/2014
EXIDIRATION DATE
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11/25/2016
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Judith,{,. Yost, Director
Division of Laboratory Services
Sunrey and Certiftcation Group
Center for Clinical Standards and Quality
1407
Certs2_120914
a Certiftcate of Compliance or Certiftcate of Accrefitation, below is a list of the laboratory
specialties/subspecialties you are certifted to perform and their effective date:
If you currendy hold
LAB CERTIFICだ HON(CODE)
EFFECTIVE DATE
ROU丁 :NE CHEM:STRY(310)
l1/26ノ 2014
HEMATOLOGY(400)
11ノ 26ノ
CWOGENEttlCS(900)
11ノ
LABI CERTIFICATION(CODD
EFFECTIVE DATE
2014
26/2014
FOR MOREINFOttMだ HON ABOUT CL]眈 ,VISIT OURVttBSITE AT VttnMcMscGOVノ CLIA
OR CONTACT YOUR LOCAL Slm『 E AGENCX PLEASESEE THE RMRSE FOR
YOUR STATE AGENCY'S ADDRⅡ 3S AND PHONE NUMIBER
PLEASE COttT YOUR STATE AGENCYFOR ANY CHANGES TO YOUR CUШ NT CERTIFICATE.