05D1039859 CLIA NUMBER - MODESTO SURGERY CENTER INC

Laboratory Demographics

  • CLIA Code: 05D1039859
  • Facility Name: MODESTO SURGERY CENTER INC
  • Facility Address: 400 E ORANGEBURG AVE STE 1
    MODESTO, CA
    ZIP 95350
  • Facility Phone: 209 526-3000
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: GREGORY TESLUK
  • NPI Number: 1356463913
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1039859
LAB Type Ambulatory Surgery Center
Facility Name MODESTO SURGERY CENTER INC
Street 400 E ORANGEBURG AVE STE 1
City MODESTO
State CA
ZIP 95350
Phone 209 526-3000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2024
Certificate Expiration Date 6/2/2026
Facility Type Ambulatory Surgery Center
Lab Director GREGORY TESLUK

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