05D0992255 CLIA NUMBER - TAREQ A ALI MD

Laboratory Demographics

  • CLIA Code: 05D0992255
  • Facility Name: TAREQ A ALI MD
  • Facility Address: 1520 W KETTLEMAN LN STE B TAREQ ALI MD FAMILY PRACTICE
    LODI, CA
    ZIP 95240
  • Facility Phone: 209 339-3797
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TAREQ A. ALI MD
  • NPI Number: 1790722718
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0992255
LAB Type Physician Office
Facility Name TAREQ A ALI MD
Street 1520 W KETTLEMAN LN STE B TAREQ ALI MD FAMILY PRACTICE
City LODI
State CA
ZIP 95240
Phone 209 339-3797
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2024
Certificate Expiration Date 6/20/2026
Facility Type Physician Office
Lab Director TAREQ A. ALI MD

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