05D1093761 CLIA NUMBER - CHEMICAL DEPENDENCY TREATMENT ASSOC INC

Laboratory Demographics

CLIA Number: 05D1093761

Facility Name: CHEMICAL DEPENDENCY TREATMENT ASSOC INC

Facility Address:
805 UNIVERSITY AVE
SACRAMENTO, CA
ZIP 95825
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Facility Phone Number: 916 333-5955

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1245767516

Taxonomy: 207RA0401X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.

CLIA Record

Field Name	Field Value
CLIA Number	05D1093761
LAB Type	Physician Office
Facility Name	CHEMICAL DEPENDENCY TREATMENT ASSOC INC
Street	805 UNIVERSITY AVE
City	SACRAMENTO
State	CA
ZIP	95825
Phone	916 333-5955
CertificateType	4
CertificateEffectiveDate	12/31/2022
CertificateExpirationDate	12/30/2024
FacilityType	Waiver

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