05D1014361 CLIA NUMBER - STANISLAUS COUNTY PUBLIC HEALTH STANISLAUS COUNTY HEALTH SVCS AGENCY OA C&T PRGM

Laboratory Demographics

  • CLIA Code: 05D1014361
  • Facility Name: STANISLAUS COUNTY PUBLIC HEALTH STANISLAUS COUNTY HEALTH SVCS AGENCY OA C&T PRGM
  • Facility Address: 1524 MCHENRY AVE STE 300
    MODESTO, CA
    ZIP 95350
  • Facility Phone: 209 558-8804
  • Facility Type: Other - PH CLINIC
  • Facility Type: Waiver
  • Lab Director: THEOGNOSIA PAPASOZOMENOS
  • NPI Number: 1639492317
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 05D1014361
LAB Type Other - PH CLINIC
Facility Name STANISLAUS COUNTY PUBLIC HEALTH STANISLAUS COUNTY HEALTH SVCS AGENCY OA C&T PRGM
Street 1524 MCHENRY AVE STE 300
City MODESTO
State CA
ZIP 95350
Phone 209 558-8804
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2025
Certificate Expiration Date 7/1/2027
Facility Type Other - PH CLINIC
Lab Director THEOGNOSIA PAPASOZOMENOS

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