05D0609827 CLIA NUMBER - VIRGILIO C ERESO MD

Laboratory Demographics

CLIA Number: 05D0609827

Facility Name: VIRGILIO C ERESO MD

Facility Address:
500 COFFEE ROAD, #A
MODESTO, CA
ZIP 95355
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Facility Phone Number: 209 579-7461

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1063698041

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0609827
LAB Type	Physician Office
Facility Name	VIRGILIO C ERESO MD
Street	500 COFFEE ROAD, #A
City	MODESTO
State	CA
ZIP	95355
Phone	209 579-7461
CertificateType	3
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024