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

Laboratory Demographics

CLIA Number: 05D1009062

Facility Name: STANISLAUS COUNTY HEALTH SERVICES AGENCY PEDIATRIC CTR

Facility Address:
830 SCENIC DR, STE A
MODESTO, CA
ZIP 95350
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Facility Phone Number: 209 558-8400

Facility Type: Other - FED QUALIFIED LOOK-LIKE

Certificate Type: Microscopy

NPI Number: 1891991741

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

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
CertificateType	3
CertificateEffectiveDate	2/5/2023
CertificateExpirationDate	2/4/2025
FacilityType	PPMP

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