14D0892234 CLIA NUMBER - ABELARDO J JARAVA MD

Laboratory Demographics

CLIA Number: 14D0892234

Facility Name: ABELARDO J JARAVA MD

Facility Address:
3336 N ASHLAND AVENUE
CHICAGO, IL
ZIP 60657
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Facility Phone Number: 312 472-2936

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740595198

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0892234
LAB Type	Physician Office
Facility Name	ABELARDO J JARAVA MD
Street	3336 N ASHLAND AVENUE
City	CHICAGO
State	IL
ZIP	60657
Phone	312 472-2936
CertificateType	4
CertificateEffectiveDate	9/27/2022
CertificateExpirationDate	9/26/2024
FacilityType	Waiver

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