03D2170075 CLIA NUMBER - ARIZONA ESSENTIAL HOLISTIC CARE, LLC

Laboratory Demographics

  • CLIA Code: 03D2170075
  • Facility Name: ARIZONA ESSENTIAL HOLISTIC CARE, LLC
  • Facility Address: 5700 W OLIVE AVE STE 102
    GLENDALE, AZ
    ZIP 85302
  • Facility Phone: 623 738-6062
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALODIA DOMINGO
  • NPI Number: 1497246482
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2170075
LAB Type Physician Office
Facility Name ARIZONA ESSENTIAL HOLISTIC CARE, LLC
Street 5700 W OLIVE AVE STE 102
City GLENDALE
State AZ
ZIP 85302
Phone 623 738-6062
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2025
Certificate Expiration Date 7/31/2027
Facility Type Physician Office
Lab Director ALODIA DOMINGO

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