03D1026754 CLIA NUMBER - PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL

Laboratory Demographics

  • CLIA Code: 03D1026754
  • Facility Name: PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL
  • Facility Address: 286 S LENZNER AVE
    SIERRA VISTA, AZ
    ZIP 85635
  • Facility Phone: 480 660-6706
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GABRIELLA THERIOT
  • NPI Number: 1205087780
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D1026754
LAB Type Physician Office
Facility Name PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL
Street 286 S LENZNER AVE
City SIERRA VISTA
State AZ
ZIP 85635
Phone 480 660-6706
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2023
Certificate Expiration Date 12/1/2025
Facility Type Physician Office
Lab Director GABRIELLA THERIOT

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