05D2144094 CLIA NUMBER - MANIBERRY HEALTHCARE SERVICE

Laboratory Demographics

  • CLIA Code: 05D2144094
  • Facility Name: MANIBERRY HEALTHCARE SERVICE
  • Facility Address: 780 W OLIVE AVE STE 104
    MERCED, CA
    ZIP 95348
  • Facility Phone: 209 349-1896
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GHOLAMREZA VAFADOUSTE, MD
  • NPI Number: 1437605110
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2144094
LAB Type Physician Office
Facility Name MANIBERRY HEALTHCARE SERVICE
Street 780 W OLIVE AVE STE 104
City MERCED
State CA
ZIP 95348
Phone 209 349-1896
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2024
Certificate Expiration Date 2/9/2026
Facility Type Physician Office
Lab Director GHOLAMREZA VAFADOUSTE, MD

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