05D2086215 CLIA NUMBER - PORT CITY DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2086215
  • Facility Name: PORT CITY DIALYSIS
  • Facility Address: 1810 FRESNO AVE
    STOCKTON, CA
    ZIP 95202
  • Facility Phone: 209 946-0738
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MALLAREDDY MADDULA
  • NPI Number: 1437569514
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2086215
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PORT CITY DIALYSIS
Street 1810 FRESNO AVE
City STOCKTON
State CA
ZIP 95202
Phone 209 946-0738
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2024
Certificate Expiration Date 10/28/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MALLAREDDY MADDULA

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