05D2320876 CLIA NUMBER - FOLSOM CITY MD

Laboratory Demographics

  • CLIA Code: 05D2320876
  • Facility Name: FOLSOM CITY MD
  • Facility Address: 1600 CREEKSIDE DR SUITE 3200
    FOLSOM, CA
    ZIP 95630
  • Facility Phone: 916 252-5000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MALATHI SHANMUGAM
  • NPI Number: 1659195766
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2320876
LAB Type Physician Office
Facility Name FOLSOM CITY MD
Street 1600 CREEKSIDE DR SUITE 3200
City FOLSOM
State CA
ZIP 95630
Phone 916 252-5000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/25/2025
Certificate Expiration Date 3/24/2027
Facility Type Physician Office
Lab Director MALATHI SHANMUGAM

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