03D2012490 CLIA NUMBER - BLOSSOM BIRTH PC

Laboratory Demographics

  • CLIA Code: 03D2012490
  • Facility Name: BLOSSOM BIRTH PC
  • Facility Address: 2928 N 18TH PLACE
    PHOENIX, AZ
    ZIP 85016
  • Facility Phone: 602 256-7766
  • Facility Type: Other - BIRTH CENTER
  • Facility Type: Microscopy
  • Lab Director: NICHELLE E. WHITEHEAD
  • NPI Number: 1679846141
  • Taxonomy: 261QB0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2012490
LAB Type Other - BIRTH CENTER
Facility Name BLOSSOM BIRTH PC
Street 2928 N 18TH PLACE
City PHOENIX
State AZ
ZIP 85016
Phone 602 256-7766
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/3/2024
Certificate Expiration Date 9/2/2026
Facility Type Other - BIRTH CENTER
Lab Director NICHELLE E. WHITEHEAD

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