05D1017797 CLIA NUMBER - MODESTO PEDIATRICS

Laboratory Demographics

  • CLIA Code: 05D1017797
  • Facility Name: MODESTO PEDIATRICS
  • Facility Address: 3109 COFFEE RD, SUITE A
    MODESTO, CA
    ZIP 95355
  • Facility Phone: 209 522-0001
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANN MARIE TRUSCELLO MD
  • NPI Number: 1366547796
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D1017797
LAB Type Physician Office
Facility Name MODESTO PEDIATRICS
Street 3109 COFFEE RD, SUITE A
City MODESTO
State CA
ZIP 95355
Phone 209 522-0001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/6/2025
Certificate Expiration Date 10/5/2027
Facility Type Physician Office
Lab Director ANN MARIE TRUSCELLO MD

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