03D2112430 CLIA NUMBER - WILLOW MIDWIFE CENTER FOR BIRTH AND WELLNESS

Laboratory Demographics

  • CLIA Code: 03D2112430
  • Facility Name: WILLOW MIDWIFE CENTER FOR BIRTH AND WELLNESS
  • Facility Address: 2045 S VINEYARD, #136
    MESA, AZ
    ZIP 85210
  • Facility Phone: 480 565-5990
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: DIANE M. ORTEGA
  • NPI Number: 1891337895
  • Taxonomy: 367A00000X - Advanced Practice Midwife

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CLIA Record

Field Name Field Value
CLIA Number 03D2112430
LAB Type Practitioner Other
Facility Name WILLOW MIDWIFE CENTER FOR BIRTH AND WELLNESS
Street 2045 S VINEYARD, #136
City MESA
State AZ
ZIP 85210
Phone 480 565-5990
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Practitioner Other
Lab Director DIANE M. ORTEGA

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