03D1100251 CLIA NUMBER - DESERT INTERVENTIONAL SPINE CONSULTANTS, LLC

Laboratory Demographics

CLIA Number: 03D1100251

Facility Name: DESERT INTERVENTIONAL SPINE CONSULTANTS, LLC

Facility Address:
1410 W GUADALUPE, STE 125
GILBERT, AZ
ZIP 85233
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Facility Phone Number: 480 838-1914

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154651750

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	03D1100251
LAB Type	Physician Office
Facility Name	DESERT INTERVENTIONAL SPINE CONSULTANTS, LLC
Street	1410 W GUADALUPE, STE 125
City	GILBERT
State	AZ
ZIP	85233
Phone	480 838-1914
CertificateType	4
CertificateEffectiveDate	6/2/2023
CertificateExpirationDate	6/1/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024