14D2004238 CLIA NUMBER - PROHEALTH MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 14D2004238
  • Facility Name: PROHEALTH MEDICAL CENTER
  • Facility Address: 2003 MONTGOMERY RD, STE 106
    AURORA, IL
    ZIP 60504
  • Facility Phone: 708 890-9115
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: IVAN R. LOPEZ
  • NPI Number: 1740512359
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2004238
LAB Type Physician Office
Facility Name PROHEALTH MEDICAL CENTER
Street 2003 MONTGOMERY RD, STE 106
City AURORA
State IL
ZIP 60504
Phone 708 890-9115
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2024
Certificate Expiration Date 2/28/2026
Facility Type Physician Office
Lab Director IVAN R. LOPEZ

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