03D2257758 CLIA NUMBER - AZ WELLNESS CLINIC

Laboratory Demographics

  • CLIA Code: 03D2257758
  • Facility Name: AZ WELLNESS CLINIC
  • Facility Address: 6114 N 59TH AVE STE 4
    GLENDALE, AZ
    ZIP 85301
  • Facility Phone: 623 937-8643
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AHECIO LABRADA IZQUIERDO
  • NPI Number: 1619436292
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 03D2257758
LAB Type Physician Office
Facility Name AZ WELLNESS CLINIC
Street 6114 N 59TH AVE STE 4
City GLENDALE
State AZ
ZIP 85301
Phone 623 937-8643
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type Physician Office
Lab Director AHECIO LABRADA IZQUIERDO

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