03D2170257 CLIA NUMBER - SONORAN FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 03D2170257

Facility Name: SONORAN FAMILY PRACTICE

Facility Address:
171 W CENTRAL AVE
COOLIDGE, AZ
ZIP 85128
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Facility Phone Number: 520 723-7726

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1922653690

Taxonomy: 363LP2300X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2170257
LAB Type	Physician Office
Facility Name	SONORAN FAMILY PRACTICE
Street	171 W CENTRAL AVE
City	COOLIDGE
State	AZ
ZIP	85128
Phone	520 723-7726
CertificateType	3
CertificateEffectiveDate	8/7/2023
CertificateExpirationDate	8/6/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024