05D2114309 CLIA NUMBER - DEER PARK DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2114309
  • Facility Name: DEER PARK DIALYSIS
  • Facility Address: 4401 MACK RD
    SACRAMENTO, CA
    ZIP 95823
  • Facility Phone: 916 738-3575
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JOHAN WINOTO
  • NPI Number: 1033584248
  • Taxonomy: 261QE0700X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2024
Certificate Expiration Date 6/9/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JOHAN WINOTO

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