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05D1000733 CLIA NUMBER - CENTRAL VALLEY PAIN MANAGEMENT AND WELLNESS CLINIC

Laboratory Demographics

CLIA Number: 05D1000733

Facility Name: CENTRAL VALLEY PAIN MANAGEMENT AND WELLNESS CLINIC

Facility Address:
1300 MABLE AVE STE 2
MODESTO, CA
ZIP 95355
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Facility Phone Number: 209 571-1992

Facility Type: Physician Office

Certificate Type: Certificate of Compliance
NPI Number: 1265565162

Taxonomy: 204C00000X - Neuromusculoskeletal Medicine, Sports Medicine
A Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician trained to be responsible for the continuous care in the field of sports medicine encompasses increased knowledge and understanding of osteopathic principles and practice and heightened technical skills of osteopathic manipulative medicine and integrates each of these into the management of the individual engaged in physical exercise (sports) whether as an individual or in team participation. Source: American Osteopathic Association Additional Resources: AOA Osteopathic Board Certification in Neuromusculoskeletal Medicine; https://certification.osteopathic.org/sports-medicine/

CLIA Record

Field Name Field Value
CLIA Number 05D1000733
LAB Type Physician Office
Facility Name CENTRAL VALLEY PAIN MANAGEMENT AND WELLNESS CLINIC
Street 1300 MABLE AVE STE 2
City MODESTO
State CA
ZIP 95355
Phone 209 571-1992
CertificateType 2
CertificateEffectiveDate 10/14/2021
CertificateExpirationDate 4/30/2024
FacilityType Compliance

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