03D2166612 CLIA NUMBER - OPTUM PRIMARY CARE - SAN TAN

Laboratory Demographics

  • CLIA Code: 03D2166612
  • Facility Name: OPTUM PRIMARY CARE - SAN TAN
  • Facility Address: 36283 N GANTZEL RD STE 101
    SAN TAN VALLEY, AZ
    ZIP 85140
  • Facility Phone: 480 351-7277
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TARA OSTROM
  • NPI Number: 1497249452
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2166612
LAB Type Physician Office
Facility Name OPTUM PRIMARY CARE - SAN TAN
Street 36283 N GANTZEL RD STE 101
City SAN TAN VALLEY
State AZ
ZIP 85140
Phone 480 351-7277
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2025
Certificate Expiration Date 5/20/2027
Facility Type Physician Office
Lab Director TARA OSTROM

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