05D2107975 CLIA NUMBER - PACHECO DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2107975
  • Facility Name: PACHECO DIALYSIS
  • Facility Address: 1245 W PACHECO BLVD
    LOS BANOS, CA
    ZIP 93635
  • Facility Phone: 209 827-3934
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KISHORE K. KALLURI, MD
  • NPI Number: 1518341171
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2107975
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PACHECO DIALYSIS
Street 1245 W PACHECO BLVD
City LOS BANOS
State CA
ZIP 93635
Phone 209 827-3934
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2024
Certificate Expiration Date 1/25/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director KISHORE K. KALLURI, MD

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