03D2093418 CLIA NUMBER - LAKE HAVASU PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 03D2093418
  • Facility Name: LAKE HAVASU PRIMARY CARE
  • Facility Address: 89 CIVIC CENTER BLVD
    LAKE HAVASU CITY, AZ
    ZIP 86403
  • Facility Phone: 928 453-0777
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ESSA J. SIDIQI
  • NPI Number: 1194116186
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2093418
LAB Type Physician Office
Facility Name LAKE HAVASU PRIMARY CARE
Street 89 CIVIC CENTER BLVD
City LAKE HAVASU CITY
State AZ
ZIP 86403
Phone 928 453-0777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2025
Certificate Expiration Date 3/25/2027
Facility Type Physician Office
Lab Director ESSA J. SIDIQI

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