03D2078893 CLIA NUMBER - DESERT VALLEY PEDIATRICS - GOODYEAR

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Laboratory Demographics

CLIA Number: 03D2078893

Facility Name: DESERT VALLEY PEDIATRICS - GOODYEAR

Facility Address:
700 N ESTRELLA PARKWAY STE 110
GOODYEAR, AZ
ZIP 85338
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Facility Phone Number: 623 877-7337

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1336354984

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2078893
LAB Type	Physician Office
Facility Name	DESERT VALLEY PEDIATRICS - GOODYEAR
Street	700 N ESTRELLA PARKWAY STE 110
City	GOODYEAR
State	AZ
ZIP	85338
Phone	623 877-7337
CertificateType	4
CertificateEffectiveDate	6/5/2022
CertificateExpirationDate	6/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024