05D1009062 CLIA NUMBER - STANISLAUS COUNTY HEALTH SERVICES AGENCY PEDIATRIC CTR

Laboratory Demographics

  • CLIA Code: 05D1009062
  • Facility Name: STANISLAUS COUNTY HEALTH SERVICES AGENCY PEDIATRIC CTR
  • Facility Address: 830 SCENIC DR, STE A
    MODESTO, CA
    ZIP 95350
  • Facility Phone: 209 558-8400
  • Facility Type: Other - FED QUALIFIED LOOK-LIKE
  • Facility Type: Microscopy
  • Lab Director: RAELEIGH PAYANES
  • NPI Number: 1891991741
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1009062
LAB Type Other - FED QUALIFIED LOOK-LIKE
Facility Name STANISLAUS COUNTY HEALTH SERVICES AGENCY PEDIATRIC CTR
Street 830 SCENIC DR, STE A
City MODESTO
State CA
ZIP 95350
Phone 209 558-8400
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 2/5/2025
Certificate Expiration Date 2/4/2027
Facility Type Other - FED QUALIFIED LOOK-LIKE
Lab Director RAELEIGH PAYANES

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