11D2163291 CLIA NUMBER - LA CLINICA

Laboratory Demographics

  • CLIA Code: 11D2163291
  • Facility Name: LA CLINICA
  • Facility Address: 10479 ALPHARETTA STREET, SUITE 18
    ROSWELL, GA
    ZIP 30075
  • Facility Phone: 770 312-1840
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: PATRICIA HERNANDEZ
  • NPI Number: 1629623343
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 11D2163291
LAB Type Practitioner Other
Facility Name LA CLINICA
Street 10479 ALPHARETTA STREET, SUITE 18
City ROSWELL
State GA
ZIP 30075
Phone 770 312-1840
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2025
Certificate Expiration Date 3/11/2027
Facility Type Practitioner Other
Lab Director PATRICIA HERNANDEZ

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