05D0609099 CLIA NUMBER - SUTTER GOULD MEDICAL FOUNDATION - SMP I OBGYN

Laboratory Demographics

  • CLIA Code: 05D0609099
  • Facility Name: SUTTER GOULD MEDICAL FOUNDATION - SMP I OBGYN
  • Facility Address: 2505 W HAMMER LANE
    STOCKTON, CA
    ZIP 95209
  • Facility Phone: 209 956-1552
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JENNIFER T. PHUNG
  • NPI Number: 1316190796
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0609099
LAB Type Physician Office
Facility Name SUTTER GOULD MEDICAL FOUNDATION - SMP I OBGYN
Street 2505 W HAMMER LANE
City STOCKTON
State CA
ZIP 95209
Phone 209 956-1552
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 9/25/2025
Certificate Expiration Date 9/24/2027
Facility Type Physician Office
Lab Director JENNIFER T. PHUNG

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