03D2111356 CLIA NUMBER - BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC

Laboratory Demographics

CLIA Number: 03D2111356

Facility Name: BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC

Facility Address:
5310 W THUNDERBIRD RD STE 310
GLENDALE, AZ
ZIP 85306
Get Directions

Facility Phone Number: (602) 865-4470

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1578125738

Taxonomy: 133NN1002X - Nutritionist

CLIA Record

Field Name	Field Value
CLIA Number	03D2111356
LAB Type	PHYSICIAN OFFICE
Facility Name	BANNER PHYSICIAN SUPER SPECIALISTS ARIZONA LLC
Street	5310 W THUNDERBIRD RD STE 310
City	GLENDALE
State	AZ
ZIP	85306
Phone	(602) 865-4470

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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