29D2015816 CLIA NUMBER - MAMA MIA PEDIATRICS LLC

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Laboratory Demographics

CLIA Number: 29D2015816

Facility Name: MAMA MIA PEDIATRICS LLC

Facility Address:
2315 E CHEYENNE AVE STE 100
N LAS VEGAS, NV
ZIP 89030
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Facility Phone Number: 702 633-4000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1780049858

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	29D2015816
LAB Type	Physician Office
Facility Name	MAMA MIA PEDIATRICS LLC
Street	2315 E CHEYENNE AVE STE 100
City	N LAS VEGAS
State	NV
ZIP	89030
Phone	702 633-4000
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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