05D2182931 CLIA NUMBER - GRANT LINE DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2182931
  • Facility Name: GRANT LINE DIALYSIS
  • Facility Address: 2955 N CORRAL HOLLOW ROAD SUITE 101
    TRACY, CA
    ZIP 95376
  • Facility Phone: 209 839-8302
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: AJAY RACHAKONDA
  • NPI Number: 1093211609
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2182931
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GRANT LINE DIALYSIS
Street 2955 N CORRAL HOLLOW ROAD SUITE 101
City TRACY
State CA
ZIP 95376
Phone 209 839-8302
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2024
Certificate Expiration Date 4/26/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director AJAY RACHAKONDA

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