05D2233235 CLIA NUMBER - GABRIEL ICF/DDN

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CLIA Record

Field Name Field Value
CLIA Number 05D2233235
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name GABRIEL ICF/DDN
Street 2155 W ELM STREET
City LODI
State CA
ZIP 95242
Phone 209 333-1904
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/20/2025
Certificate Expiration Date 8/19/2027
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director AZIZULAH KAMALI

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