29D1002688 CLIA NUMBER - CALDERON MEDICAL GROUP-W CHARLESTON

Laboratory Demographics

  • CLIA Code: 29D1002688
  • Facility Name: CALDERON MEDICAL GROUP-W CHARLESTON
  • Facility Address: 3000 W CHARLESTON BLVD STE 5
    LAS VEGAS, NV
    ZIP 89102
  • Facility Phone: 702 877-9511
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BENITO C. CALDERON
  • NPI Number: 1134363781
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 29D1002688
LAB Type Physician Office
Facility Name CALDERON MEDICAL GROUP-W CHARLESTON
Street 3000 W CHARLESTON BLVD STE 5
City LAS VEGAS
State NV
ZIP 89102
Phone 702 877-9511
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2024
Certificate Expiration Date 8/12/2026
Facility Type Physician Office
Lab Director BENITO C. CALDERON

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