29D2159215 CLIA NUMBER - ACTIVATE HEALTHCARE-LOCAL 525 BUFFALO CLINIC

Laboratory Demographics

  • CLIA Code: 29D2159215
  • Facility Name: ACTIVATE HEALTHCARE-LOCAL 525 BUFFALO CLINIC
  • Facility Address: 911 N BUFFALO DR UNIT 113
    LAS VEGAS, NV
    ZIP 89128
  • Facility Phone: 702 960-4441
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATHLEEN T. WAGNER
  • NPI Number: 1407481997
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 29D2159215
LAB Type Physician Office
Facility Name ACTIVATE HEALTHCARE-LOCAL 525 BUFFALO CLINIC
Street 911 N BUFFALO DR UNIT 113
City LAS VEGAS
State NV
ZIP 89128
Phone 702 960-4441
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Physician Office
Lab Director KATHLEEN T. WAGNER

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