03D2084103 CLIA NUMBER - SOBA MESA LLC - BROADWAY

Laboratory Demographics

  • CLIA Code: 03D2084103
  • Facility Name: SOBA MESA LLC - BROADWAY
  • Facility Address: 6262 E BROADWAY RD, STE 110
    MESA, AZ
    ZIP 85206
  • Facility Phone: 310 457-5250
  • Facility Type: Other - TREATMENT FACILITY
  • Facility Type: Waiver
  • Lab Director: JENNIFER N. OHARA
  • NPI Number: 1144670951
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2084103
LAB Type Other - TREATMENT FACILITY
Facility Name SOBA MESA LLC - BROADWAY
Street 6262 E BROADWAY RD, STE 110
City MESA
State AZ
ZIP 85206
Phone 310 457-5250
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2024
Certificate Expiration Date 9/17/2026
Facility Type Other - TREATMENT FACILITY
Lab Director JENNIFER N. OHARA

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