45D0499891 CLIA NUMBER - LIVE OAK DIALYSIS

Laboratory Demographics

  • CLIA Code: 45D0499891
  • Facility Name: LIVE OAK DIALYSIS
  • Facility Address: 6700 RANDOLPH BLVD SUITE 101
    SAN ANTONIO, TX
    ZIP 78233
  • Facility Phone: 210 590-0103
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: GERARDO CHICA
  • NPI Number: 1992905525
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D0499891
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LIVE OAK DIALYSIS
Street 6700 RANDOLPH BLVD SUITE 101
City SAN ANTONIO
State TX
ZIP 78233
Phone 210 590-0103
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director GERARDO CHICA

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