29D1022978 CLIA NUMBER - SANTA ROSA MEDICAL CENTRE INC

Laboratory Demographics

CLIA Number: 29D1022978

Facility Name: SANTA ROSA MEDICAL CENTRE INC

Facility Address:
4161 S EASTERN AVE STE B3
LAS VEGAS, NV
ZIP 89119
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Facility Phone Number: 702 693-6222

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1184676728

Taxonomy: 363AM0700X - Physician Assistant

CLIA Record

Field Name	Field Value
CLIA Number	29D1022978
LAB Type	Practitioner Other
Facility Name	SANTA ROSA MEDICAL CENTRE INC
Street	4161 S EASTERN AVE STE B3
City	LAS VEGAS
State	NV
ZIP	89119
Phone	702 693-6222
CertificateType	4
CertificateEffectiveDate	3/4/2024
CertificateExpirationDate	3/3/2026
FacilityType	Waiver

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