03D2287482 CLIA NUMBER - RADIANT ADULT MEDICAL GROUP

Laboratory Demographics

CLIA Number: 03D2287482

Facility Name: RADIANT ADULT MEDICAL GROUP

Facility Address:
1025 W 24TH ST STE 26
YUMA, AZ
ZIP 85364
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Facility Phone Number: 928 318-6910

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1255976403

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	03D2287482
LAB Type	Physician Office
Facility Name	RADIANT ADULT MEDICAL GROUP
Street	1025 W 24TH ST STE 26
City	YUMA
State	AZ
ZIP	85364
Phone	928 318-6910
CertificateType	4
CertificateEffectiveDate	8/15/2023
CertificateExpirationDate	8/14/2025
FacilityType	Waiver

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