03D2244450 CLIA NUMBER - DESERT LIFE PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 03D2244450
  • Facility Name: DESERT LIFE PRIMARY CARE LLC
  • Facility Address: 3035 S ELLSWORTH RD STE 121
    MESA, AZ
    ZIP 85212
  • Facility Phone: 480 280-7229
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHIRENE K. WOODHAM
  • NPI Number: 1649943655
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 03D2244450
LAB Type Physician Office
Facility Name DESERT LIFE PRIMARY CARE LLC
Street 3035 S ELLSWORTH RD STE 121
City MESA
State AZ
ZIP 85212
Phone 480 280-7229
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2023
Certificate Expiration Date 11/30/2025
Facility Type Physician Office
Lab Director SHIRENE K. WOODHAM

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