05D1046264 CLIA NUMBER - KAISER FOUNDATION HOSPITAL MANTECA

Laboratory Demographics

  • CLIA Code: 05D1046264
  • Facility Name: KAISER FOUNDATION HOSPITAL MANTECA
  • Facility Address: 1777 WEST YOSEMITE AVE
    MANTECA, CA
    ZIP 95337
  • Facility Phone: 209 735-6552
  • Facility Type: Hospital
  • Facility Type: Microscopy
  • Lab Director: YAFEI REN
  • NPI Number: 1649327958
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D1046264
LAB Type Hospital
Facility Name KAISER FOUNDATION HOSPITAL MANTECA
Street 1777 WEST YOSEMITE AVE
City MANTECA
State CA
ZIP 95337
Phone 209 735-6552
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 10/4/2025
Certificate Expiration Date 10/3/2027
Facility Type Hospital
Lab Director YAFEI REN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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