05D2057173 CLIA NUMBER - Tully Dialysis

Laboratory Demographics

CLIA Number: 05D2057173

Facility Name: Tully Dialysis

Facility Address:
1290 Tully Rd., Ste. 80,
San Jose, CA
ZIP 95122
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Facility Phone Number: (408) 993-8959

Facility Type: END STAGE RENAL DISEASE DIALYSIS

Certificate Type: Waiver

NPI Number: 1154668184

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 05D2057173
LAB Type END STAGE RENAL DISEASE DIALYSIS
Facility Name Tully Dialysis
Street 1290 Tully Rd., Ste. 80,
City San Jose
State CA
ZIP 95122
Phone 4089938959

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This page was last updated on: 5/19/2019