66D1058111 CLIA NUMBER - ST JUDE RENAL CARE FACILITY

Laboratory Demographics

  • CLIA Code: 66D1058111
  • Facility Name: ST JUDE RENAL CARE FACILITY
  • Facility Address: KULOT DE ROSA DR
    SAIPAN MARIANA ISLANDS, MP
    ZIP 96950
  • Facility Phone: 670 234-2901
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: VICENTE S. ALDAN,MD
  • NPI Number: 1093769739
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 66D1058111
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name ST JUDE RENAL CARE FACILITY
Street KULOT DE ROSA DR
City SAIPAN MARIANA ISLANDS
State MP
ZIP 96950
Phone 670 234-2901
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/29/2024
Certificate Expiration Date 8/28/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director VICENTE S. ALDAN,MD

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