03D2051302 CLIA NUMBER - ROYAL AZ LLC

Laboratory Demographics

  • CLIA Code: 03D2051302
  • Facility Name: ROYAL AZ LLC
  • Facility Address: 831 GAIL GARDNER WAY
    PRESCOTT, AZ
    ZIP 86301
  • Facility Phone: 928 445-5591
  • Facility Type: Other - DETOXIFICATION FACILITY
  • Facility Type: Waiver
  • Lab Director: LISA TOMSAK
  • NPI Number: 1356092860
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2051302
LAB Type Other - DETOXIFICATION FACILITY
Facility Name ROYAL AZ LLC
Street 831 GAIL GARDNER WAY
City PRESCOTT
State AZ
ZIP 86301
Phone 928 445-5591
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Other - DETOXIFICATION FACILITY
Lab Director LISA TOMSAK

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