05D2060637 CLIA NUMBER - FOLSOM LAKE PRIMARY CARE, PC

Laboratory Demographics

  • CLIA Code: 05D2060637
  • Facility Name: FOLSOM LAKE PRIMARY CARE, PC
  • Facility Address: 2575 E BIDWELL ST, STE 210
    FOLSOM, CA
    ZIP 95630
  • Facility Phone: 916 984-7850
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HADI FIROZ
  • NPI Number: 1043705718
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2060637
LAB Type Physician Office
Facility Name FOLSOM LAKE PRIMARY CARE, PC
Street 2575 E BIDWELL ST, STE 210
City FOLSOM
State CA
ZIP 95630
Phone 916 984-7850
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2025
Certificate Expiration Date 5/2/2027
Facility Type Physician Office
Lab Director HADI FIROZ

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