05D1059584 CLIA NUMBER - MEMORIAL HOSPITAL LOS BANOS/RURAL HEALTH CLINIC

Laboratory Demographics

CLIA Number: 05D1059584

Facility Name: MEMORIAL HOSPITAL LOS BANOS/RURAL HEALTH CLINIC

Facility Address:
1253 WEST I ST
LOS BANOS, CA
ZIP 93635
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Facility Phone Number: 209 710-6333

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1528202090

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1059584
LAB Type	Rural Health Clinic
Facility Name	MEMORIAL HOSPITAL LOS BANOS/RURAL HEALTH CLINIC
Street	1253 WEST I ST
City	LOS BANOS
State	CA
ZIP	93635
Phone	209 710-6333
CertificateType	4
CertificateEffectiveDate	3/13/2023
CertificateExpirationDate	3/12/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024