03D0969533 CLIA NUMBER - SHAFA MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 03D0969533

Facility Name: SHAFA MEDICAL CLINIC

Facility Address:
202 E EARLL DR STE 150
PHOENIX, AZ
ZIP 85012
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Facility Phone Number: 602 248-8258

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1194906925

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	03D0969533
LAB Type	Physician Office
Facility Name	SHAFA MEDICAL CLINIC
Street	202 E EARLL DR STE 150
City	PHOENIX
State	AZ
ZIP	85012
Phone	602 248-8258
CertificateType	4
CertificateEffectiveDate	1/19/2024
CertificateExpirationDate	1/18/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024