14D1078393 CLIA NUMBER - OLIVO MEDICAL & WELLNESS CENTER

Laboratory Demographics

CLIA Number: 14D1078393

Facility Name: OLIVO MEDICAL & WELLNESS CENTER

Facility Address:
2901 N CLYBOURN AVE
CHICAGO, IL
ZIP 60618
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Facility Phone Number: 773 423-6178

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740304757

Taxonomy: 261QX0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1078393
LAB Type	Physician Office
Facility Name	OLIVO MEDICAL & WELLNESS CENTER
Street	2901 N CLYBOURN AVE
City	CHICAGO
State	IL
ZIP	60618
Phone	773 423-6178
CertificateType	4
CertificateEffectiveDate	1/9/2024
CertificateExpirationDate	1/8/2026
FacilityType	Waiver

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