05D2296140 CLIA NUMBER - LGTC WILLOW GLEN

Laboratory Demographics

  • CLIA Code: 05D2296140
  • Facility Name: LGTC WILLOW GLEN
  • Facility Address: 1551 HAMILTON AVE
    SAN JOSE, CA
    ZIP 95125
  • Facility Phone: 408 505-1873
  • Facility Type: Other - GROUP HOME FACILITY
  • Facility Type: Waiver
  • Lab Director: KARTHIK RAMGOPAL
  • NPI Number: 1710749494
  • Taxonomy: 133V00000X - Dietitian, Registered

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CLIA Record

Field Name Field Value
CLIA Number 05D2296140
LAB Type Other - GROUP HOME FACILITY
Facility Name LGTC WILLOW GLEN
Street 1551 HAMILTON AVE
City SAN JOSE
State CA
ZIP 95125
Phone 408 505-1873
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/21/2023
Certificate Expiration Date 12/20/2025
Facility Type Other - GROUP HOME FACILITY
Lab Director KARTHIK RAMGOPAL

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