03D0527961 CLIA NUMBER - PREVENTATIVE HEALTH ALLIANCE

Laboratory Demographics

  • CLIA Code: 03D0527961
  • Facility Name: PREVENTATIVE HEALTH ALLIANCE
  • Facility Address: 3201 W PEORIA AVE, STE C-604
    PHOENIX, AZ
    ZIP 85029
  • Facility Phone: 602 993-1773
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATHERINE E. GROSS
  • NPI Number: 1063294247
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D0527961
LAB Type Physician Office
Facility Name PREVENTATIVE HEALTH ALLIANCE
Street 3201 W PEORIA AVE, STE C-604
City PHOENIX
State AZ
ZIP 85029
Phone 602 993-1773
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 Physician Office
Lab Director KATHERINE E. GROSS

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