03D2153676 CLIA NUMBER - DESERT RIDGE MEDICAL GROUP LLC

Laboratory Demographics

  • CLIA Code: 03D2153676
  • Facility Name: DESERT RIDGE MEDICAL GROUP LLC
  • Facility Address: 21001 N TATUM BLVD SUITE 78-1640
    PHOENIX, AZ
    ZIP 85050
  • Facility Phone: 480 306-7832
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARTHA REYES
  • NPI Number: 1821680539
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 03D2153676
LAB Type Physician Office
Facility Name DESERT RIDGE MEDICAL GROUP LLC
Street 21001 N TATUM BLVD SUITE 78-1640
City PHOENIX
State AZ
ZIP 85050
Phone 480 306-7832
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2024
Certificate Expiration Date 8/27/2026
Facility Type Physician Office
Lab Director MARTHA REYES

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