03D2123430 CLIA NUMBER - PROTOTYPE HEALTH, INC

Laboratory Demographics

  • CLIA Code: 03D2123430
  • Facility Name: PROTOTYPE HEALTH, INC
  • Facility Address: 205 E SOUTHERN AVE, #103
    MESA, AZ
    ZIP 85210
  • Facility Phone: 480 999-1717
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMI KUPPERMAN
  • NPI Number: 1861165144
  • Taxonomy: 175F00000X - Naturopath

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CLIA Record

Field Name Field Value
CLIA Number 03D2123430
LAB Type Physician Office
Facility Name PROTOTYPE HEALTH, INC
Street 205 E SOUTHERN AVE, #103
City MESA
State AZ
ZIP 85210
Phone 480 999-1717
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2024
Certificate Expiration Date 12/19/2026
Facility Type Physician Office
Lab Director JAMI KUPPERMAN

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