05D2079717 CLIA NUMBER - WATERFORD COMMUNITY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 05D2079717
  • Facility Name: WATERFORD COMMUNITY HEALTH CENTER
  • Facility Address: 12146 YOSEMITE BLVD
    WATERFORD, CA
    ZIP 95386
  • Facility Phone: 209 847-3011
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: CHAITANYA N. MAHIDA
  • NPI Number: 1437503356
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 05D2079717
LAB Type Rural Health Clinic
Facility Name WATERFORD COMMUNITY HEALTH CENTER
Street 12146 YOSEMITE BLVD
City WATERFORD
State CA
ZIP 95386
Phone 209 847-3011
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/23/2024
Certificate Expiration Date 6/22/2026
Facility Type Rural Health Clinic
Lab Director CHAITANYA N. MAHIDA

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