03D0980440 CLIA NUMBER - OPTUM PRIMARY CARE-GILBERT BASELINE

Laboratory Demographics

  • CLIA Code: 03D0980440
  • Facility Name: OPTUM PRIMARY CARE-GILBERT BASELINE
  • Facility Address: 3048 E BASELINE RD, #120
    MESA, AZ
    ZIP 85204
  • Facility Phone: 480 505-3276
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TARA OSTROM
  • NPI Number: 1720153810
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D0980440
LAB Type Physician Office
Facility Name OPTUM PRIMARY CARE-GILBERT BASELINE
Street 3048 E BASELINE RD, #120
City MESA
State AZ
ZIP 85204
Phone 480 505-3276
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2024
Certificate Expiration Date 11/20/2026
Facility Type Physician Office
Lab Director TARA OSTROM

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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