03D2031112 CLIA NUMBER - MODOCUROGYN ,PLLC

Laboratory Demographics

  • CLIA Code: 03D2031112
  • Facility Name: MODOCUROGYN ,PLLC
  • Facility Address: 6632 E BASELINE RD, STE 101
    MESA, AZ
    ZIP 85206
  • Facility Phone: 480 889-2654
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: KRISETTE HAWN
  • NPI Number: 1538445812
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 03D2031112
LAB Type Ancillary Testing Site in Health Care Center
Facility Name MODOCUROGYN ,PLLC
Street 6632 E BASELINE RD, STE 101
City MESA
State AZ
ZIP 85206
Phone 480 889-2654
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2023
Certificate Expiration Date 10/11/2025
Facility Type Ancillary Testing Site in Health Care Center
Lab Director KRISETTE HAWN

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