05D1021372 CLIA NUMBER - GAUTAMI AGASTYA MD, INC

Laboratory Demographics

  • CLIA Code: 05D1021372
  • Facility Name: GAUTAMI AGASTYA MD, INC
  • Facility Address: 652 W 11TH ST STE 137
    TRACY, CA
    ZIP 95376
  • Facility Phone: 209 833-7555
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GAUTAMI AGASTYA MD
  • NPI Number: 1356312516
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1021372
LAB Type Physician Office
Facility Name GAUTAMI AGASTYA MD, INC
Street 652 W 11TH ST STE 137
City TRACY
State CA
ZIP 95376
Phone 209 833-7555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/21/2024
Certificate Expiration Date 1/20/2026
Facility Type Physician Office
Lab Director GAUTAMI AGASTYA MD

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