03D2138594 CLIA NUMBER - INNOVATIVE PRIMARY CARE OF LAKE HAVASU

Laboratory Demographics

CLIA Number: 03D2138594

Facility Name: INNOVATIVE PRIMARY CARE OF LAKE HAVASU

Facility Address:
1945 MESQUITE AVE, STE B
LAKE HAVASU CITY, AZ
ZIP 86403
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Facility Phone Number: (928) 733-6287

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1619633088

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2138594
LAB Type	PHYSICIAN OFFICE
Facility Name	INNOVATIVE PRIMARY CARE OF LAKE HAVASU
Street	1945 MESQUITE AVE, STE B
City	LAKE HAVASU CITY
State	AZ
ZIP	86403
Phone	(928) 733-6287

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