03D2320464 CLIA NUMBER - LEGENDARY MOBILE PHLEBOTOMY & LAB LLC

Laboratory Demographics

  • CLIA Code: 03D2320464
  • Facility Name: LEGENDARY MOBILE PHLEBOTOMY & LAB LLC
  • Facility Address: 8317 W MONROE ST
    TOLLESON, AZ
    ZIP 85353
  • Facility Phone: 602 632-3104
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: LAKISHA R. HODGE
  • NPI Number: 1649060757
  • Taxonomy: 246RP1900X - Technician, Pathology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D2320464
LAB Type Mobile Laboratory
Facility Name LEGENDARY MOBILE PHLEBOTOMY & LAB LLC
Street 8317 W MONROE ST
City TOLLESON
State AZ
ZIP 85353
Phone 602 632-3104
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2025
Certificate Expiration Date 3/17/2027
Facility Type Mobile Laboratory
Lab Director LAKISHA R. HODGE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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