05D0609050 CLIA NUMBER - SUTTER GOULD MEDICAL FOUNDATION SMP I INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 05D0609050
  • Facility Name: SUTTER GOULD MEDICAL FOUNDATION SMP I INTERNAL MEDICINE
  • Facility Address: ATTN INTERNAL MEDICINE, 2ND FL 2505 WEST HAMMER LANE
    STOCKTON, CA
    ZIP 95209
  • Facility Phone: 209 954-3370
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PETER DRUMMOND
  • NPI Number: 1891741963
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0609050
LAB Type Physician Office
Facility Name SUTTER GOULD MEDICAL FOUNDATION SMP I INTERNAL MEDICINE
Street ATTN INTERNAL MEDICINE, 2ND FL 2505 WEST HAMMER LANE
City STOCKTON
State CA
ZIP 95209
Phone 209 954-3370
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/23/2024
Certificate Expiration Date 3/22/2026
Facility Type Physician Office
Lab Director PETER DRUMMOND

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This page was last updated on: 9/29/2025