03D0925554 CLIA NUMBER - VERSATILE MEDICINE PLLC DBA LA LOMA INTERNAL MEDICINE AND PEDIATRICS

Laboratory Demographics

  • CLIA Code: 03D0925554
  • Facility Name: VERSATILE MEDICINE PLLC DBA LA LOMA INTERNAL MEDICINE AND PEDIATRICS
  • Facility Address: 13055 W MCDOWELL RD STE E-106
    AVONDALE, AZ
    ZIP 85392
  • Facility Phone: 623 975-8400
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: KATHLEEN NICHOLS, MD
  • NPI Number: 1326145608
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D0925554
LAB Type Community Clinic
Facility Name VERSATILE MEDICINE PLLC DBA LA LOMA INTERNAL MEDICINE AND PEDIATRICS
Street 13055 W MCDOWELL RD STE E-106
City AVONDALE
State AZ
ZIP 85392
Phone 623 975-8400
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/28/2025
Certificate Expiration Date 2/27/2027
Facility Type Community Clinic
Lab Director KATHLEEN NICHOLS, MD

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