03D2121574 CLIA NUMBER - MATERNAL FETAL MEDICINE AND GENETICS, PLC

Laboratory Demographics

  • CLIA Code: 03D2121574
  • Facility Name: MATERNAL FETAL MEDICINE AND GENETICS, PLC
  • Facility Address: 1772 E BOSTON ST, STE 107
    GILBERT, AZ
    ZIP 85295
  • Facility Phone: 480 636-6441
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUSAN E. PONKEY
  • NPI Number: 1003273822
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2121574
LAB Type Physician Office
Facility Name MATERNAL FETAL MEDICINE AND GENETICS, PLC
Street 1772 E BOSTON ST, STE 107
City GILBERT
State AZ
ZIP 85295
Phone 480 636-6441
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2024
Certificate Expiration Date 11/7/2026
Facility Type Physician Office
Lab Director SUSAN E. PONKEY

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This page was last updated on: 3/20/2025