03D0935533 CLIA NUMBER - OPTUM PRIMARY CARE - SUN CITY WEST - GRANITE VALLEY

Laboratory Demographics

  • CLIA Code: 03D0935533
  • Facility Name: OPTUM PRIMARY CARE - SUN CITY WEST - GRANITE VALLEY
  • Facility Address: 14506 W GRANITE VALLEY DR STE 102
    SUN CITY WEST, AZ
    ZIP 85375
  • Facility Phone: 623 214-1809
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TARA OSTROM
  • NPI Number: 1497861181
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D0935533
LAB Type Physician Office
Facility Name OPTUM PRIMARY CARE - SUN CITY WEST - GRANITE VALLEY
Street 14506 W GRANITE VALLEY DR STE 102
City SUN CITY WEST
State AZ
ZIP 85375
Phone 623 214-1809
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2023
Certificate Expiration Date 10/30/2025
Facility Type Physician Office
Lab Director TARA OSTROM

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