14D1070060 CLIA NUMBER - MY DOC S C - LILLIAN FOCA-MUNOZ

Laboratory Demographics

CLIA Number: 14D1070060

Facility Name: MY DOC S C - LILLIAN FOCA-MUNOZ

Facility Address:
2403 S OAKLEY AVE, #1
CHICAGO, IL
ZIP 60608
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Facility Phone Number: 773 376-0160

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1376746198

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1070060
LAB Type	Physician Office
Facility Name	MY DOC S C - LILLIAN FOCA-MUNOZ
Street	2403 S OAKLEY AVE, #1
City	CHICAGO
State	IL
ZIP	60608
Phone	773 376-0160
CertificateType	4
CertificateEffectiveDate	6/20/2023
CertificateExpirationDate	6/19/2025
FacilityType	Waiver

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