05D2058646 CLIA NUMBER - CALIFORNIA HEALTH CARE FACILITY CLINICAL LABORATOR

Laboratory Demographics

  • CLIA Code: 05D2058646
  • Facility Name: CALIFORNIA HEALTH CARE FACILITY CLINICAL LABORATOR
  • Facility Address: 7707 S. AUSTIN RD FACILITY SHARED SVCS., BLDG. 201
    STOCKTON, CA
    ZIP 95215
  • Facility Phone: 209 467-4809
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: ANISE ADAMS
  • NPI Number: 1548893779
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2058646
LAB Type Prison
Facility Name CALIFORNIA HEALTH CARE FACILITY CLINICAL LABORATOR
Street 7707 S. AUSTIN RD FACILITY SHARED SVCS., BLDG. 201
City STOCKTON
State CA
ZIP 95215
Phone 209 467-4809
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2025
Certificate Expiration Date 5/8/2027
Facility Type Prison
Lab Director ANISE ADAMS

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This page was last updated on: 6/4/2025