05D2057173 CLIA NUMBER - TULLY DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2057173
  • Facility Name: TULLY DIALYSIS
  • Facility Address: 614 TULLY RD STE 30
    SAN JOSE, CA
    ZIP 95122
  • Facility Phone: 408 993-8959
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ZINEB BENMAYOUF, MD
  • NPI Number: 1154668184
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2057173
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name TULLY DIALYSIS
Street 614 TULLY RD STE 30
City SAN JOSE
State CA
ZIP 95122
Phone 408 993-8959
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2025
Certificate Expiration Date 4/9/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ZINEB BENMAYOUF, MD

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