05D2107975 CLIA NUMBER - PACHECO DIALYSIS

Laboratory Demographics

CLIA Number: 05D2107975

Facility Name: PACHECO DIALYSIS

Facility Address:
1245 W PACHECO BLVD
LOS BANOS, CA
ZIP 93635
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Facility Phone Number: 209 827-3934

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1518341171

Taxonomy: 261QE0700X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	1/26/2024
CertificateExpirationDate	1/25/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024