03D2229068 CLIA NUMBER - PROSPER INTEGRATED HEALTH CARE

Laboratory Demographics

CLIA Number: 03D2229068

Facility Name: PROSPER INTEGRATED HEALTH CARE

Facility Address:
10750 W MCDOWELL RD STE C305
AVONDALE, AZ
ZIP 85392
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Facility Phone Number: 623 440-1633

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1629659578

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D2229068
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	PROSPER INTEGRATED HEALTH CARE
Street	10750 W MCDOWELL RD STE C305
City	AVONDALE
State	AZ
ZIP	85392
Phone	623 440-1633
CertificateType	4
CertificateEffectiveDate	7/6/2023
CertificateExpirationDate	7/5/2025
FacilityType	Waiver

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