03D0968005 CLIA NUMBER - SOUTH PHOENIX COMMUNITY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 03D0968005
  • Facility Name: SOUTH PHOENIX COMMUNITY HEALTH CENTER
  • Facility Address: 26 E BASELINE RD STE 121
    PHOENIX, AZ
    ZIP 85042
  • Facility Phone: 602 243-3455
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: RAUL D. ROMERO MD
  • NPI Number: 1063738524
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D0968005
LAB Type Physician Office
Facility Name SOUTH PHOENIX COMMUNITY HEALTH CENTER
Street 26 E BASELINE RD STE 121
City PHOENIX
State AZ
ZIP 85042
Phone 602 243-3455
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 11/30/2023
Certificate Expiration Date 11/29/2025
Facility Type Physician Office
Lab Director RAUL D. ROMERO MD

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