03D2266070 CLIA NUMBER - SAGEBRUSH DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 03D2266070
  • Facility Name: SAGEBRUSH DERMATOLOGY
  • Facility Address: 5432 E SOUTHERN AVE STE 101B
    MESA, AZ
    ZIP 85206
  • Facility Phone: 480 681-3376
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHAO LI
  • NPI Number: 1174274435
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 03D2266070
LAB Type Physician Office
Facility Name SAGEBRUSH DERMATOLOGY
Street 5432 E SOUTHERN AVE STE 101B
City MESA
State AZ
ZIP 85206
Phone 480 681-3376
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/6/2024
Certificate Expiration Date 12/5/2026
Facility Type Physician Office
Lab Director CHAO LI

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