05D2114309 CLIA NUMBER - DEER PARK DIALYSIS

Laboratory Demographics

CLIA Number: 05D2114309

Facility Name: DEER PARK DIALYSIS

Facility Address:
4401 MACK RD
SACRAMENTO, CA
ZIP 95823
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Facility Phone Number: 916 738-3575

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1033584248

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2114309
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	DEER PARK DIALYSIS
Street	4401 MACK RD
City	SACRAMENTO
State	CA
ZIP	95823
Phone	916 738-3575
CertificateType	4
CertificateEffectiveDate	6/10/2022
CertificateExpirationDate	6/9/2024
FacilityType	Waiver

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