05D2294366 CLIA NUMBER - MEMORIAL MEDICAL CENTER - INFUSION CENTER

Laboratory Demographics

  • CLIA Code: 05D2294366
  • Facility Name: MEMORIAL MEDICAL CENTER - INFUSION CENTER
  • Facility Address: 1800 COFFEE ROAD SUITE 52
    MODESTO, CA
    ZIP 95355
  • Facility Phone: 209 530-3753
  • Facility Type: Other - INFUSION CENTER
  • Facility Type: Waiver
  • Lab Director: HARVEY CHANG
  • NPI Number: 1043246747
  • Taxonomy: 3336I0012X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2294366
LAB Type Other - INFUSION CENTER
Facility Name MEMORIAL MEDICAL CENTER - INFUSION CENTER
Street 1800 COFFEE ROAD SUITE 52
City MODESTO
State CA
ZIP 95355
Phone 209 530-3753
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/22/2023
Certificate Expiration Date 11/21/2025
Facility Type Other - INFUSION CENTER
Lab Director HARVEY CHANG

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