05D0706846 CLIA NUMBER - SUTTER GOULD MEDICAL FOUNDATION-LODI OBGYN

Laboratory Demographics

  • CLIA Code: 05D0706846
  • Facility Name: SUTTER GOULD MEDICAL FOUNDATION-LODI OBGYN
  • Facility Address: 999 S FAIRMONT AVE STE 200
    LODI, CA
    ZIP 95240
  • Facility Phone: 209 334-3322
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: PATRICIA KENNEL
  • NPI Number: 1477912517
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 05D0706846
LAB Type Physician Office
Facility Name SUTTER GOULD MEDICAL FOUNDATION-LODI OBGYN
Street 999 S FAIRMONT AVE STE 200
City LODI
State CA
ZIP 95240
Phone 209 334-3322
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 9/25/2024
Certificate Expiration Date 9/24/2026
Facility Type Physician Office
Lab Director PATRICIA KENNEL

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