03D2111520 CLIA NUMBER - Bella Vita Healthcare

Laboratory Demographics

CLIA Number: 03D2111520

Facility Name: Bella Vita Healthcare

Facility Address:
203 S Candy Lane, Ste 6ab
Cottonwood, AZ
ZIP 86326
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Facility Phone Number: (928) 634-0391

Facility Type: OTHER PRACTITIONER

Certificate Type: Waiver

NPI Number: 1245691625

Taxonomy: 363LW0102X - Nurse Practitioner

CLIA Record

Field Name Field Value
CLIA Number 03D2111520
LAB Type OTHER PRACTITIONER
Facility Name Bella Vita Healthcare
Street 203 S Candy Lane, Ste 6ab
City Cottonwood
State AZ
ZIP 86326
Phone (928) 634-0391

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This page was last updated on: 4/7/2021