03D1105938 CLIA NUMBER - GLENDALE PEDIATRICS, LLC

Laboratory Demographics

  • CLIA Code: 03D1105938
  • Facility Name: GLENDALE PEDIATRICS, LLC
  • Facility Address: 2929 N 75TH AVE, SUITE 5 & 6
    PHOENIX, AZ
    ZIP 85033
  • Facility Phone: 623 873-1200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ENRIQUE S. LOPEZ, MD
  • NPI Number: 1043074610
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D1105938
LAB Type Physician Office
Facility Name GLENDALE PEDIATRICS, LLC
Street 2929 N 75TH AVE, SUITE 5 & 6
City PHOENIX
State AZ
ZIP 85033
Phone 623 873-1200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2023
Certificate Expiration Date 9/30/2025
Facility Type Physician Office
Lab Director ENRIQUE S. LOPEZ, MD

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