03D2126966 CLIA NUMBER - CLEANSLATE CENTERS

Laboratory Demographics

CLIA Number: 03D2126966

Facility Name: CLEANSLATE CENTERS

Facility Address:
15255 N 40TH ST, BLDG 5, STE 135
PHOENIX, AZ
ZIP 85032
Get Directions

Facility Phone Number: (413) 584-2173

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1194264911

Taxonomy: 207RA0401X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine.

CLIA Record

Field Name	Field Value
CLIA Number	03D2126966
LAB Type	PHYSICIAN OFFICE
Facility Name	CLEANSLATE CENTERS
Street	15255 N 40TH ST, BLDG 5, STE 135
City	PHOENIX
State	AZ
ZIP	85032
Phone	(413) 584-2173

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

This page was last updated on: 5/11/2023