05D2136177 CLIA NUMBER - HEALTHWORKS MED GROUP OF CALIFORNIA, A MEDICAL CORPORATION ROCHE HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D2136177

Facility Name: HEALTHWORKS MED GROUP OF CALIFORNIA, A MEDICAL CORPORATION ROCHE HEALTH CENTER

Facility Address:
4300 HACIENDA DR
PLEASANTON, CA
ZIP 94588
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Facility Phone Number: 925 251-6878

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760900104

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2136177
LAB Type	Physician Office
Facility Name	HEALTHWORKS MED GROUP OF CALIFORNIA, A MEDICAL CORPORATION ROCHE HEALTH CENTER
Street	4300 HACIENDA DR
City	PLEASANTON
State	CA
ZIP	94588
Phone	925 251-6878
CertificateType	4
CertificateEffectiveDate	9/5/2023
CertificateExpirationDate	9/4/2025
FacilityType	Waiver

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