05D0954551 CLIA NUMBER - DON PEDRO FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 05D0954551
  • Facility Name: DON PEDRO FAMILY PRACTICE
  • Facility Address: 3191 EL PRADO SUITE D
    LA GRANGE, CA
    ZIP 95329
  • Facility Phone: 209 852-2764
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DON M. ENDRESS
  • NPI Number: 1104145861
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 05D0954551
LAB Type Physician Office
Facility Name DON PEDRO FAMILY PRACTICE
Street 3191 EL PRADO SUITE D
City LA GRANGE
State CA
ZIP 95329
Phone 209 852-2764
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Physician Office
Lab Director DON M. ENDRESS

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