29D0538774 CLIA NUMBER - INTERMOUNTAIN HEALTHCARE - LA CANADA ONCOLOGY

Laboratory Demographics

CLIA Number: 29D0538774

Facility Name: INTERMOUNTAIN HEALTHCARE - LA CANADA ONCOLOGY

Facility Address:
3131 LA CANADA ST, SUITE 140
LAS VEGAS, NV
ZIP 89169
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Facility Phone Number: 702 735-7154

Facility Type: Physician Office

Certificate Type: Accreditation

NPI Number: 1326261298

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	29D0538774
LAB Type	Physician Office
Facility Name	INTERMOUNTAIN HEALTHCARE - LA CANADA ONCOLOGY
Street	3131 LA CANADA ST, SUITE 140
City	LAS VEGAS
State	NV
ZIP	89169
Phone	702 735-7154
CertificateType	1
CertificateEffectiveDate	10/10/2022
CertificateExpirationDate	10/9/2024
FacilityType	Accreditation

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