03D1075689 CLIA NUMBER - CHICANOS POR LA CAUSA, INC

Laboratory Demographics

CLIA Number: 03D1075689

Facility Name: CHICANOS POR LA CAUSA, INC

Facility Address:
325 N STAPLEY DR
MESA, AZ
ZIP 85203
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Facility Phone Number: (602) 257-0700

Facility Type: OTHER

Certificate Type: Waiver

NPI Number: 1386294437

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D1075689
LAB Type	OTHER
Facility Name	CHICANOS POR LA CAUSA, INC
Street	325 N STAPLEY DR
City	MESA
State	AZ
ZIP	85203
Phone	(602) 257-0700

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This page was last updated on: 5/11/2023