29D2065859 CLIA NUMBER - HUNTRIDGE FAMILY CLINIC

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Laboratory Demographics

CLIA Number: 29D2065859

Facility Name: HUNTRIDGE FAMILY CLINIC

Facility Address:
1820 E SAHARA AVE SUITE 201
LAS VEGAS, NV
ZIP 89104
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Facility Phone Number: 702 979-1111

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1134553068

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	29D2065859
LAB Type	Practitioner Other
Facility Name	HUNTRIDGE FAMILY CLINIC
Street	1820 E SAHARA AVE SUITE 201
City	LAS VEGAS
State	NV
ZIP	89104
Phone	702 979-1111
CertificateType	4
CertificateEffectiveDate	9/16/2023
CertificateExpirationDate	9/15/2025
FacilityType	Waiver

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