05D0997419 CLIA NUMBER - INTISAB SULTAN MD

Laboratory Demographics

  • CLIA Code: 05D0997419
  • Facility Name: INTISAB SULTAN MD
  • Facility Address: 2256 DOCKERY AVE STE A
    SELMA, CA
    ZIP 93662
  • Facility Phone: 559 891-0100
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: INTISAB SULTAN MD
  • NPI Number: 1548362296
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0997419
LAB Type Physician Office
Facility Name INTISAB SULTAN MD
Street 2256 DOCKERY AVE STE A
City SELMA
State CA
ZIP 93662
Phone 559 891-0100
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/18/2025
Certificate Expiration Date 10/17/2027
Facility Type Physician Office
Lab Director INTISAB SULTAN MD

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