05D0589791 CLIA NUMBER - ILDEFONSO CRUZ MD

Laboratory Demographics

  • CLIA Code: 05D0589791
  • Facility Name: ILDEFONSO CRUZ MD
  • Facility Address: 1646 E HERNDON #102
    FRESNO, CA
    ZIP 93720
  • Facility Phone: 559 449-7300
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ILDEFONSO CRUZ
  • NPI Number: 1275689085
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0589791
LAB Type Physician Office
Facility Name ILDEFONSO CRUZ MD
Street 1646 E HERNDON #102
City FRESNO
State CA
ZIP 93720
Phone 559 449-7300
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director ILDEFONSO CRUZ

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This page was last updated on: 6/4/2025