03D2115803 CLIA NUMBER - ONE MEDICAL - ELLSWORTH

Laboratory Demographics

  • CLIA Code: 03D2115803
  • Facility Name: ONE MEDICAL - ELLSWORTH
  • Facility Address: 9124 E MAIN ST, SUITES 20-21
    MESA, AZ
    ZIP 85207
  • Facility Phone: 480 295-8070
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GIAO X. QUACH
  • NPI Number: 1700235751
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2115803
LAB Type Physician Office
Facility Name ONE MEDICAL - ELLSWORTH
Street 9124 E MAIN ST, SUITES 20-21
City MESA
State AZ
ZIP 85207
Phone 480 295-8070
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2024
Certificate Expiration Date 4/2/2026
Facility Type Physician Office
Lab Director GIAO X. QUACH

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