03D2072275 CLIA NUMBER - CCR-OTC LLC

Laboratory Demographics

  • CLIA Code: 03D2072275
  • Facility Name: CCR-OTC LLC
  • Facility Address: 819 W GURLEY ST STE A&C
    PRESCOTT, AZ
    ZIP 86305
  • Facility Phone: 928 671-0161
  • Facility Type: Other - CO-IOP
  • Facility Type: Waiver
  • Lab Director: MONA AMINI
  • NPI Number: 1700281219
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2072275
LAB Type Other - CO-IOP
Facility Name CCR-OTC LLC
Street 819 W GURLEY ST STE A&C
City PRESCOTT
State AZ
ZIP 86305
Phone 928 671-0161
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2024
Certificate Expiration Date 1/27/2026
Facility Type Other - CO-IOP
Lab Director MONA AMINI

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