03D2101446 CLIA NUMBER - OMNI DERMATOLOGY, INC

Laboratory Demographics

  • Code: 03D2101446
  • Facility Name: OMNI DERMATOLOGY, INC
  • Facility Address: 4515 S MCCLINTOCK DR STE 101
    TEMPE, AZ
    ZIP 85282
  • Facility Phone: 602 559-5470
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • NPI Number: 1639611130
  • Taxonomy: 174400000X - Specialist
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CLIA Record

Field Name Field Value
CLIA Number 03D2101446
LAB Type Physician Office
Facility Name OMNI DERMATOLOGY, INC
Street 4515 S MCCLINTOCK DR STE 101
City TEMPE
State AZ
ZIP 85282
Phone 602 559-5470
Certificate Type 2
Certificate Effective Date 4/23/2022
Certificate Expiration Date 4/30/2024
Facility Type Compliance

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