03D2100784 CLIA NUMBER - VALLEY INTEGRATED WELLNESS, LLC

Laboratory Demographics

  • CLIA Code: 03D2100784
  • Facility Name: VALLEY INTEGRATED WELLNESS, LLC
  • Facility Address: 21585 N 77TH AVE, #1500
    PEORIA, AZ
    ZIP 85382
  • Facility Phone: 413 822-2601
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: SANDRA L. DECARLO
  • NPI Number: 1477920064
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 03D2100784
LAB Type Community Clinic
Facility Name VALLEY INTEGRATED WELLNESS, LLC
Street 21585 N 77TH AVE, #1500
City PEORIA
State AZ
ZIP 85382
Phone 413 822-2601
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2023
Certificate Expiration Date 8/20/2025
Facility Type Community Clinic
Lab Director SANDRA L. DECARLO

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This page was last updated on: 3/20/2025