03D2100784 CLIA NUMBER - VALLEY INTEGRATED WELLNESS, LLC

Laboratory Demographics

CLIA Number: 03D2100784

Facility Name: VALLEY INTEGRATED WELLNESS, LLC

Facility Address:
21585 N 77TH AVE, #1500
PEORIA, AZ
ZIP 85382
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Facility Phone Number: (413) 822-2601

Facility Type: COMMUNITY CLINIC

Certificate Type: Waiver

NPI Number: 1477920064

Taxonomy: 363LF0000X - Nurse Practitioner

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

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This page was last updated on: 5/11/2023