06D2030568 CLIA NUMBER - CASTILLO PRIMARY CARE

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Laboratory Demographics

CLIA Number: 06D2030568

Facility Name: CASTILLO PRIMARY CARE

Facility Address:
1401 ANITA ST
PUEBLO, CO
ZIP 81001
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Facility Phone Number: 719 225-6510

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1912293374

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D2030568
LAB Type	Practitioner Other
Facility Name	CASTILLO PRIMARY CARE
Street	1401 ANITA ST
City	PUEBLO
State	CO
ZIP	81001
Phone	719 225-6510
CertificateType	4
CertificateEffectiveDate	9/29/2023
CertificateExpirationDate	9/28/2025
FacilityType	Waiver

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