05D1091036 CLIA NUMBER - LAGUNA ICF

Laboratory Demographics

CLIA Code: 05D1091036
Facility Name: LAGUNA ICF
Facility Address: 294 LAGUNA DRIVE
TRACY, CA
ZIP 95376
Facility Phone: 209 835-0824
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: PRANJALKUMAR H. PATEL MD
NPI Number: 1336290014
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

Map and Directions

Get Directions

CLIA Record

Field Name	Field Value
CLIA Number	05D1091036
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	LAGUNA ICF
Street	294 LAGUNA DRIVE
City	TRACY
State	CA
ZIP	95376
Phone	209 835-0824
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	10/23/2024
Certificate Expiration Date	10/22/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	PRANJALKUMAR H. PATEL MD

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