45D2304694 CLIA NUMBER - ONCOLOGY SAN ANTONIO - DT

Laboratory Demographics

  • CLIA Code: 45D2304694
  • Facility Name: ONCOLOGY SAN ANTONIO - DT
  • Facility Address: 202 BALTIMORE AVE
    SAN ANTONIO, TX
    ZIP 78215
  • Facility Phone: 210 490-2707
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SREECHARAN MAVURAM
  • NPI Number: 1790180370
  • Taxonomy: 207RH0003X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2304694
LAB Type Physician Office
Facility Name ONCOLOGY SAN ANTONIO - DT
Street 202 BALTIMORE AVE
City SAN ANTONIO
State TX
ZIP 78215
Phone 210 490-2707
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2024
Certificate Expiration Date 5/15/2026
Facility Type Physician Office
Lab Director SREECHARAN MAVURAM

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