03D2271859 CLIA NUMBER - PRIMEGYN WOMEN'S CENTER

Laboratory Demographics

CLIA Number: 03D2271859

Facility Name: PRIMEGYN WOMEN'S CENTER

Facility Address:
20325 N 51ST AVE STE 100
GLENDALE, AZ
ZIP 85308
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Facility Phone Number: 602 848-2520

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1649995028

Taxonomy: 363LW0102X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2271859
LAB Type	Physician Office
Facility Name	PRIMEGYN WOMEN'S CENTER
Street	20325 N 51ST AVE STE 100
City	GLENDALE
State	AZ
ZIP	85308
Phone	602 848-2520
CertificateType	4
CertificateEffectiveDate	11/9/2022
CertificateExpirationDate	11/8/2024
FacilityType	Waiver

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