19D2103572 CLIA NUMBER - THE BONIN CLINIC LLC

Laboratory Demographics

  • CLIA Code: 19D2103572
  • Facility Name: THE BONIN CLINIC LLC
  • Facility Address: 1215 INDEPENDENCE BLVD, 1A
    ZACHARY, LA
    ZIP 70791
  • Facility Phone: 225 570-2010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: OTTO J. BONIN
  • NPI Number: 1003280512
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2103572
LAB Type Physician Office
Facility Name THE BONIN CLINIC LLC
Street 1215 INDEPENDENCE BLVD, 1A
City ZACHARY
State LA
ZIP 70791
Phone 225 570-2010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2025
Certificate Expiration Date 10/14/2027
Facility Type Physician Office
Lab Director OTTO J. BONIN

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