05D0958816 CLIA NUMBER - VIJAY C KATUKOTA, A MEDICAL CORPORATION

Laboratory Demographics

  • CLIA Code: 05D0958816
  • Facility Name: VIJAY C KATUKOTA, A MEDICAL CORPORATION
  • Facility Address: 1177 N PARK AVENUE
    POMONA, CA
    ZIP 91768
  • Facility Phone: 909 623-9900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VIJAY C. KATUKOTA MD
  • NPI Number: 1013954825
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 05D0958816
LAB Type Physician Office
Facility Name VIJAY C KATUKOTA, A MEDICAL CORPORATION
Street 1177 N PARK AVENUE
City POMONA
State CA
ZIP 91768
Phone 909 623-9900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2025
Certificate Expiration Date 3/25/2027
Facility Type Physician Office
Lab Director VIJAY C. KATUKOTA MD

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