05D2095753 CLIA NUMBER - ADVENTIST HEALTH LODI MEMORIAL

Laboratory Demographics

  • CLIA Code: 05D2095753
  • Facility Name: ADVENTIST HEALTH LODI MEMORIAL
  • Facility Address: 800 S LOWER SACRAMENTO RD
    LODI, CA
    ZIP 95242
  • Facility Phone: 209 339-7441
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEVIN J. BUCKMAN
  • NPI Number: 1750878922
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 05D2095753
LAB Type Physician Office
Facility Name ADVENTIST HEALTH LODI MEMORIAL
Street 800 S LOWER SACRAMENTO RD
City LODI
State CA
ZIP 95242
Phone 209 339-7441
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Physician Office
Lab Director KEVIN J. BUCKMAN

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