05D0890580 CLIA NUMBER - PORTERVILLE DEV CENTER

Laboratory Demographics

  • CLIA Code: 05D0890580
  • Facility Name: PORTERVILLE DEV CENTER
  • Facility Address: 26501 AVE 140
    PORTERVILLE, CA
    ZIP 93257
  • Facility Phone: 209 782-2222
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: R SRINIVASAN
  • NPI Number: 1184083644
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0890580
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name PORTERVILLE DEV CENTER
Street 26501 AVE 140
City PORTERVILLE
State CA
ZIP 93257
Phone 209 782-2222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2024
Certificate Expiration Date 8/21/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director R SRINIVASAN

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