05D2174081 CLIA NUMBER - LEONID BASOVICH DO INC

Laboratory Demographics

  • CLIA Code: 05D2174081
  • Facility Name: LEONID BASOVICH DO INC
  • Facility Address: 7777 GREENBACK LANE SUITE 103
    CITRUS HEIGHTS, CA
    ZIP 95610
  • Facility Phone: 916 905-1777
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BASOVICH LEONID
  • NPI Number: 1285626515
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2174081
LAB Type Physician Office
Facility Name LEONID BASOVICH DO INC
Street 7777 GREENBACK LANE SUITE 103
City CITRUS HEIGHTS
State CA
ZIP 95610
Phone 916 905-1777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2023
Certificate Expiration Date 10/22/2025
Facility Type Physician Office
Lab Director BASOVICH LEONID

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