05D2222610 CLIA NUMBER - COFFEE ROAD DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2222610
  • Facility Name: COFFEE ROAD DIALYSIS
  • Facility Address: 1328 COFFEE RD
    MODESTO, CA
    ZIP 95355
  • Facility Phone: 209 491-3690
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: AUJLA HARLEEN
  • NPI Number: 1558301713
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D2222610
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name COFFEE ROAD DIALYSIS
Street 1328 COFFEE RD
City MODESTO
State CA
ZIP 95355
Phone 209 491-3690
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director AUJLA HARLEEN

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