05D0989666 CLIA NUMBER - KRISHNAMOORTHI, MD, INC

Laboratory Demographics

  • CLIA Code: 05D0989666
  • Facility Name: KRISHNAMOORTHI, MD, INC
  • Facility Address: 2222 E ORANGEBURG AVE STE A2
    MODESTO, CA
    ZIP 95355
  • Facility Phone: 209 525-3121
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SOMA KRISHNAMOORTHI
  • NPI Number: 1528119435
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0989666
LAB Type Physician Office
Facility Name KRISHNAMOORTHI, MD, INC
Street 2222 E ORANGEBURG AVE STE A2
City MODESTO
State CA
ZIP 95355
Phone 209 525-3121
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2025
Certificate Expiration Date 7/31/2027
Facility Type Physician Office
Lab Director SOMA KRISHNAMOORTHI

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