03D0903856 CLIA NUMBER - OPTUM PRIMARY CARE TALAVI BOULEVARD

Laboratory Demographics

  • CLIA Code: 03D0903856
  • Facility Name: OPTUM PRIMARY CARE TALAVI BOULEVARD
  • Facility Address: 5651 W TALAVI BLVD STE 170
    GLENDALE, AZ
    ZIP 85306
  • Facility Phone: 602 843-1313
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TARA OSTROM
  • NPI Number: 1568673499
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D0903856
LAB Type Physician Office
Facility Name OPTUM PRIMARY CARE TALAVI BOULEVARD
Street 5651 W TALAVI BLVD STE 170
City GLENDALE
State AZ
ZIP 85306
Phone 602 843-1313
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2025
Certificate Expiration Date 4/16/2027
Facility Type Physician Office
Lab Director TARA OSTROM

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