05D2067077 CLIA NUMBER - COMMUNITY FOUNDATION MEDICAL GROUP NORTHWEST MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2067077
  • Facility Name: COMMUNITY FOUNDATION MEDICAL GROUP NORTHWEST MEDICAL GROUP
  • Facility Address: 7355 N PALM AVE STE 100
    FRESNO, CA
    ZIP 93711
  • Facility Phone: 559 297-1776
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NATALYA MALLEY MD
  • NPI Number: 1578637716
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 05D2067077
LAB Type Physician Office
Facility Name COMMUNITY FOUNDATION MEDICAL GROUP NORTHWEST MEDICAL GROUP
Street 7355 N PALM AVE STE 100
City FRESNO
State CA
ZIP 93711
Phone 559 297-1776
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/8/2025
Certificate Expiration Date 10/7/2027
Facility Type Physician Office
Lab Director NATALYA MALLEY MD

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