29D1010709 CLIA NUMBER - MAVIS N MATSUMOTO, MD, LLC

Laboratory Demographics

  • CLIA Code: 29D1010709
  • Facility Name: MAVIS N MATSUMOTO, MD, LLC
  • Facility Address: 2780 HORIZON RIDGE PKWY STE 30
    HENDERSON, NV
    ZIP 89052
  • Facility Phone: 702 992-4050
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MAVIS N. MATSUMOTO MD
  • NPI Number: 1942213558
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 29D1010709
LAB Type Physician Office
Facility Name MAVIS N MATSUMOTO, MD, LLC
Street 2780 HORIZON RIDGE PKWY STE 30
City HENDERSON
State NV
ZIP 89052
Phone 702 992-4050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/21/2025
Certificate Expiration Date 3/20/2027
Facility Type Physician Office
Lab Director MAVIS N. MATSUMOTO MD

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