03D1073977 CLIA NUMBER - PHOENIX CHILDREN'S PEDIATRICS

Laboratory Demographics

  • CLIA Code: 03D1073977
  • Facility Name: PHOENIX CHILDREN'S PEDIATRICS
  • Facility Address: 1501 N GILBERT RD STE 203
    GILBERT, AZ
    ZIP 85234
  • Facility Phone: 602 933-5060
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DENNIS DIETZEN
  • NPI Number: 1922112044
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 03D1073977
LAB Type Practitioner Other
Facility Name PHOENIX CHILDREN'S PEDIATRICS
Street 1501 N GILBERT RD STE 203
City GILBERT
State AZ
ZIP 85234
Phone 602 933-5060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2023
Certificate Expiration Date 12/8/2025
Facility Type Practitioner Other
Lab Director DENNIS DIETZEN

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