05D1046549 CLIA NUMBER - OLIVE TREE WELLNESS CENTER, INC

Laboratory Demographics

  • CLIA Code: 05D1046549
  • Facility Name: OLIVE TREE WELLNESS CENTER, INC
  • Facility Address: 1146 OLIVEWOOD DR
    MERCED, CA
    ZIP 95348
  • Facility Phone: 209 723-0019
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAM ROUSSOS, DO
  • NPI Number: 1295997419
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1046549
LAB Type Physician Office
Facility Name OLIVE TREE WELLNESS CENTER, INC
Street 1146 OLIVEWOOD DR
City MERCED
State CA
ZIP 95348
Phone 209 723-0019
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2025
Certificate Expiration Date 10/11/2027
Facility Type Physician Office
Lab Director PAM ROUSSOS, DO

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