21D2119638 CLIA NUMBER - LA CLINICA DEL PUEBLO- HYATTSVILLE SITE

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Laboratory Demographics

CLIA Number: 21D2119638

Facility Name: LA CLINICA DEL PUEBLO- HYATTSVILLE SITE

Facility Address:
2970 BELCREST CENTER DR, UNIT #301
HYATTSVILLE, MD
ZIP 20782
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Facility Phone Number: 202 462-4788

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1124227590

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2119638
LAB Type	Federally Qualified Health Center
Facility Name	LA CLINICA DEL PUEBLO- HYATTSVILLE SITE
Street	2970 BELCREST CENTER DR, UNIT #301
City	HYATTSVILLE
State	MD
ZIP	20782
Phone	202 462-4788
CertificateType	3
CertificateEffectiveDate	9/30/2022
CertificateExpirationDate	9/29/2024
FacilityType	PPMP

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