05D1102955 CLIA NUMBER - GASTROENTEROLOGY MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 05D1102955

Facility Name: GASTROENTEROLOGY MEDICAL CLINIC

Facility Address:
1580 CREEKSIDE DR STE 200
FOLSOM, CA
ZIP 95630
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Facility Phone Number: 916 293-9117

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1578741401

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D1102955
LAB Type	Physician Office
Facility Name	GASTROENTEROLOGY MEDICAL CLINIC
Street	1580 CREEKSIDE DR STE 200
City	FOLSOM
State	CA
ZIP	95630
Phone	916 293-9117
CertificateType	2
CertificateEffectiveDate	9/29/2021
CertificateExpirationDate	4/30/2024
FacilityType	Compliance

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