03D2303660 CLIA NUMBER - ARIZONA MOBILE NP

Laboratory Demographics

  • CLIA Code: 03D2303660
  • Facility Name: ARIZONA MOBILE NP
  • Facility Address: 37107 N YELLOWSTONE DR
    SAN TAN VALLEY, AZ
    ZIP 85140
  • Facility Phone: 480 522-0260
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: CHARLES M. COMBS
  • NPI Number: 1972381564
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D2303660
LAB Type Practitioner Other
Facility Name ARIZONA MOBILE NP
Street 37107 N YELLOWSTONE DR
City SAN TAN VALLEY
State AZ
ZIP 85140
Phone 480 522-0260
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2024
Certificate Expiration Date 4/28/2026
Facility Type Practitioner Other
Lab Director CHARLES M. COMBS

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