05D0862377 CLIA NUMBER - GARY R JOHNSON MD

Laboratory Demographics

  • CLIA Code: 05D0862377
  • Facility Name: GARY R JOHNSON MD
  • Facility Address: 588 W ST CHARLES ST
    SAN ANDREAS, CA
    ZIP 95249
  • Facility Phone: 209 754-1851
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: GARY R. JOHNSON MD
  • NPI Number: 1114013513
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0862377
LAB Type Physician Office
Facility Name GARY R JOHNSON MD
Street 588 W ST CHARLES ST
City SAN ANDREAS
State CA
ZIP 95249
Phone 209 754-1851
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director GARY R. JOHNSON MD

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