05D0896731 CLIA NUMBER - PROHEALTH MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D0896731
  • Facility Name: PROHEALTH MEDICAL GROUP
  • Facility Address: 1401 SPANOS CT STE 122
    MODESTO, CA
    ZIP 95355
  • Facility Phone: 209 529-2052
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: EDWARD L. AUEN MD
  • NPI Number: 1760670988
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 05D0896731
LAB Type Physician Office
Facility Name PROHEALTH MEDICAL GROUP
Street 1401 SPANOS CT STE 122
City MODESTO
State CA
ZIP 95355
Phone 209 529-2052
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 7/1/2024
Certificate Expiration Date 6/30/2026
Facility Type Physician Office
Lab Director EDWARD L. AUEN MD

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