03D2270784 CLIA NUMBER - AURORA HEALTH AND WELLNESS LLC

Laboratory Demographics

CLIA Number: 03D2270784

Facility Name: AURORA HEALTH AND WELLNESS LLC

Facility Address:
4494 W PEORIA AVE #115A STE 5
GLENDALE, AZ
ZIP 85302
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Facility Phone Number: 682 667-9019

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1407572381

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2270784
LAB Type	Practitioner Other
Facility Name	AURORA HEALTH AND WELLNESS LLC
Street	4494 W PEORIA AVE #115A STE 5
City	GLENDALE
State	AZ
ZIP	85302
Phone	682 667-9019
CertificateType	4
CertificateEffectiveDate	10/20/2022
CertificateExpirationDate	10/19/2024
FacilityType	Waiver

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