03D2109708 CLIA NUMBER - BANNER PHYSICIAN SPECIALISTS ARIZONA LLC

Laboratory Demographics

  • CLIA Code: 03D2109708
  • Facility Name: BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
  • Facility Address: 1435 S ALMA SCHOOL RD
    CHANDLER, AZ
    ZIP 85286
  • Facility Phone: 480 668-1670
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VIVEK R. KESARA
  • NPI Number: 1649908831
  • Taxonomy: 133NN1002X - Nutritionist

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CLIA Record

Field Name Field Value
CLIA Number 03D2109708
LAB Type Physician Office
Facility Name BANNER PHYSICIAN SPECIALISTS ARIZONA LLC
Street 1435 S ALMA SCHOOL RD
City CHANDLER
State AZ
ZIP 85286
Phone 480 668-1670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2024
Certificate Expiration Date 2/28/2026
Facility Type Physician Office
Lab Director VIVEK R. KESARA

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This page was last updated on: 6/4/2025