14D0978732 CLIA NUMBER - GUSTAVO RICARDO SANCHEZ-VARGAS MD SC

Laboratory Demographics

CLIA Number: 14D0978732

Facility Name: GUSTAVO RICARDO SANCHEZ-VARGAS MD SC

Facility Address:
523 WEST GALENA BLVD
AURORA, IL
ZIP 60506
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Facility Phone Number: 630 966-9701

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1255514089

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	14D0978732
LAB Type	Physician Office
Facility Name	GUSTAVO RICARDO SANCHEZ-VARGAS MD SC
Street	523 WEST GALENA BLVD
City	AURORA
State	IL
ZIP	60506
Phone	630 966-9701
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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