03D0996967 CLIA NUMBER - CORNERSTONE FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 03D0996967
  • Facility Name: CORNERSTONE FAMILY MEDICINE
  • Facility Address: 4545 E SOUTHERN AVE STE 103
    MESA, AZ
    ZIP 85206
  • Facility Phone: 480 981-6100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEFFERY D. WILDEN
  • NPI Number: 1376664540
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D0996967
LAB Type Physician Office
Facility Name CORNERSTONE FAMILY MEDICINE
Street 4545 E SOUTHERN AVE STE 103
City MESA
State AZ
ZIP 85206
Phone 480 981-6100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2024
Certificate Expiration Date 2/28/2026
Facility Type Physician Office
Lab Director JEFFERY D. WILDEN

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