05D1077647 CLIA NUMBER - TRACY SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 05D1077647
  • Facility Name: TRACY SURGERY CENTER, LLC
  • Facility Address: 2160 W GRANT LINE RD SUITE 120
    TRACY, CA
    ZIP 95377
  • Facility Phone: 209 836-5680
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SALMAN RAZI MD
  • NPI Number: 1013104389
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1077647
LAB Type Ambulatory Surgery Center
Facility Name TRACY SURGERY CENTER, LLC
Street 2160 W GRANT LINE RD SUITE 120
City TRACY
State CA
ZIP 95377
Phone 209 836-5680
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/14/2023
Certificate Expiration Date 12/13/2025
Facility Type Ambulatory Surgery Center
Lab Director SALMAN RAZI MD

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