03D2105162 CLIA NUMBER - PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL

Laboratory Demographics

  • CLIA Code: 03D2105162
  • Facility Name: PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL
  • Facility Address: 3552 W BASELINE RD, STE 140
    LAVEEN, AZ
    ZIP 85339
  • Facility Phone: 602 635-6951
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GABRIELLA HANCOCK
  • NPI Number: 1255196754
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2105162
LAB Type Physician Office
Facility Name PRESCOTT HEALTHCARE SOLUTIONS LLC DBA OPTIMA MEDICAL
Street 3552 W BASELINE RD, STE 140
City LAVEEN
State AZ
ZIP 85339
Phone 602 635-6951
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2023
Certificate Expiration Date 11/18/2025
Facility Type Physician Office
Lab Director GABRIELLA HANCOCK

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