05D0989666 CLIA NUMBER - KRISHNAMOORTHI, MD, INC

Laboratory Demographics

CLIA Number: 05D0989666

Facility Name: KRISHNAMOORTHI, MD, INC

Facility Address:
2222 E ORANGEBURG AVE STE A2
MODESTO, CA
ZIP 95355
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Facility Phone Number: 209 525-3121

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1528119435

Taxonomy: 261QP2300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	8/1/2023
CertificateExpirationDate	7/31/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024