05D0864107 CLIA NUMBER - RADIATION ONCOLOGY MEDICAL ASSOCIATES

Laboratory Demographics

  • CLIA Code: 05D0864107
  • Facility Name: RADIATION ONCOLOGY MEDICAL ASSOCIATES
  • Facility Address: 2027 GRAND CANAL, SUITE #25
    STOCKTON, CA
    ZIP 95207
  • Facility Phone: 209 475-1111
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD C. GREENLEAF
  • NPI Number: 1346468840
  • Taxonomy: 2085R0001X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 05D0864107
LAB Type Physician Office
Facility Name RADIATION ONCOLOGY MEDICAL ASSOCIATES
Street 2027 GRAND CANAL, SUITE #25
City STOCKTON
State CA
ZIP 95207
Phone 209 475-1111
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 Physician Office
Lab Director EDWARD C. GREENLEAF

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