05D1035050 CLIA NUMBER - SUTTER GOULD MEDICAL FOUNDATION - OB / GYN

Laboratory Demographics

  • CLIA Code: 05D1035050
  • Facility Name: SUTTER GOULD MEDICAL FOUNDATION - OB / GYN
  • Facility Address: 1401 SPANOS CT
    MODESTO, CA
    ZIP 95355
  • Facility Phone: 209 672-7208
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. WILSON SAWA
  • NPI Number: 1780631820
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1035050
LAB Type Physician Office
Facility Name SUTTER GOULD MEDICAL FOUNDATION - OB / GYN
Street 1401 SPANOS CT
City MODESTO
State CA
ZIP 95355
Phone 209 672-7208
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 12/20/2024
Certificate Expiration Date 12/19/2026
Facility Type Physician Office
Lab Director DR. WILSON SAWA

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