05D0858104 CLIA NUMBER - SUTTER ALHAMBRA SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 05D0858104
  • Facility Name: SUTTER ALHAMBRA SURGERY CENTER
  • Facility Address: 1201 ALHAMBRA BLVD, STE 110
    ELK GROVE, CA
    ZIP 95757
  • Facility Phone: 916 733-8222
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JAIME L. DICKERSON
  • NPI Number: 1770541708
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0858104
LAB Type Ambulatory Surgery Center
Facility Name SUTTER ALHAMBRA SURGERY CENTER
Street 1201 ALHAMBRA BLVD, STE 110
City ELK GROVE
State CA
ZIP 95757
Phone 916 733-8222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Ambulatory Surgery Center
Lab Director JAIME L. DICKERSON

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