29D0970104 CLIA NUMBER - MOUNTAIN VISTA PEDIATRICS

Laboratory Demographics

  • CLIA Code: 29D0970104
  • Facility Name: MOUNTAIN VISTA PEDIATRICS
  • Facility Address: 6301 MTN VISTA STE 205
    HENDERSON, NV
    ZIP 89014
  • Facility Phone: 702 685-5543
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDMUND L. FARO
  • NPI Number: 1538595368
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 29D0970104
LAB Type Physician Office
Facility Name MOUNTAIN VISTA PEDIATRICS
Street 6301 MTN VISTA STE 205
City HENDERSON
State NV
ZIP 89014
Phone 702 685-5543
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2024
Certificate Expiration Date 2/2/2026
Facility Type Physician Office
Lab Director EDMUND L. FARO

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