03D0667429 CLIA NUMBER - PHOENIX CHILDREN'S PEDIATRICS - PARADISE VALLEY

Laboratory Demographics

CLIA Number: 03D0667429

Facility Name: PHOENIX CHILDREN'S PEDIATRICS - PARADISE VALLEY

Facility Address:
4848 E CACTUS RD #620
SCOTTSDALE, AZ
ZIP 85254
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Facility Phone Number: 602 933-6335

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053655746

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D0667429
LAB Type	Physician Office
Facility Name	PHOENIX CHILDREN'S PEDIATRICS - PARADISE VALLEY
Street	4848 E CACTUS RD #620
City	SCOTTSDALE
State	AZ
ZIP	85254
Phone	602 933-6335
CertificateType	4
CertificateEffectiveDate	4/30/2023
CertificateExpirationDate	4/29/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024