03D0699858 CLIA NUMBER - PUEBLO FAMILY PHYSICIANS

Laboratory Demographics

  • CLIA Code: 03D0699858
  • Facility Name: PUEBLO FAMILY PHYSICIANS
  • Facility Address: 4350 N 19TH AVE SUITE 6
    PHOENIX, AZ
    ZIP 85015
  • Facility Phone: 602 264-9191
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DONALD G. CUNNINGHAM DO
  • NPI Number: 1790798072
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D0699858
LAB Type Physician Office
Facility Name PUEBLO FAMILY PHYSICIANS
Street 4350 N 19TH AVE SUITE 6
City PHOENIX
State AZ
ZIP 85015
Phone 602 264-9191
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 DONALD G. CUNNINGHAM DO

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