03D2204214 CLIA NUMBER - FORWARD CARE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 03D2204214
  • Facility Name: FORWARD CARE FAMILY PRACTICE
  • Facility Address: 7800 N 55TH AVE STE 106
    GLENDALE, AZ
    ZIP 85301
  • Facility Phone: 602 718-1962
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ELLANA DAVIDOV
  • NPI Number: 1205435880
  • Taxonomy: 363A00000X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 03D2204214
LAB Type Physician Office
Facility Name FORWARD CARE FAMILY PRACTICE
Street 7800 N 55TH AVE STE 106
City GLENDALE
State AZ
ZIP 85301
Phone 602 718-1962
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2024
Certificate Expiration Date 12/7/2026
Facility Type Physician Office
Lab Director ELLANA DAVIDOV

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