03D1047480 CLIA NUMBER - PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL

Laboratory Demographics

  • CLIA Code: 03D1047480
  • Facility Name: PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL
  • Facility Address: 4135 S POWER RD SUITE 129
    MESA, AZ
    ZIP 85212
  • Facility Phone: 480 900-7256
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GABRIELLE HANCOCK
  • NPI Number: 1487600219
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D1047480
LAB Type Physician Office
Facility Name PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL
Street 4135 S POWER RD SUITE 129
City MESA
State AZ
ZIP 85212
Phone 480 900-7256
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/7/2023
Certificate Expiration Date 11/6/2025
Facility Type Physician Office
Lab Director GABRIELLE HANCOCK

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