03D0962320 CLIA NUMBER - OPTUM PRIMARY CARE-DEER VALLEY

Laboratory Demographics

  • CLIA Code: 03D0962320
  • Facility Name: OPTUM PRIMARY CARE-DEER VALLEY
  • Facility Address: 20040 N 19TH AVE, STE A
    PHOENIX, AZ
    ZIP 85027
  • Facility Phone: 623 869-5000
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: TARA OSTROM
  • NPI Number: 1629439005
  • Taxonomy: 207XS0114X - Orthopaedic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 03D0962320
LAB Type Community Clinic
Facility Name OPTUM PRIMARY CARE-DEER VALLEY
Street 20040 N 19TH AVE, STE A
City PHOENIX
State AZ
ZIP 85027
Phone 623 869-5000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/30/2025
Certificate Expiration Date 6/29/2027
Facility Type Community Clinic
Lab Director TARA OSTROM

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