05D0929401 CLIA NUMBER - CAMERON PARK DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D0929401
  • Facility Name: CAMERON PARK DIALYSIS
  • Facility Address: 3311 COACH LANE STE C
    CAMERON PARK, CA
    ZIP 95682
  • Facility Phone: 530 677-5114
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: VIJAY MUDUNURI
  • NPI Number: 1497030852
  • Taxonomy: 261QE0700X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D0929401
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name CAMERON PARK DIALYSIS
Street 3311 COACH LANE STE C
City CAMERON PARK
State CA
ZIP 95682
Phone 530 677-5114
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2025
Certificate Expiration Date 6/11/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director VIJAY MUDUNURI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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