29D2163416 CLIA NUMBER - ANGELES MEDICAL CENTERS LLC

Laboratory Demographics

CLIA Number: 29D2163416

Facility Name: ANGELES MEDICAL CENTERS LLC

Facility Address:
2123 CIVIC CENTER DR
NORTH LAS VEGAS, NV
ZIP 89030
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Facility Phone Number: 702 333-0110

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1609327931

Taxonomy: 363LP2300X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	29D2163416
LAB Type	Physician Office
Facility Name	ANGELES MEDICAL CENTERS LLC
Street	2123 CIVIC CENTER DR
City	NORTH LAS VEGAS
State	NV
ZIP	89030
Phone	702 333-0110
CertificateType	4
CertificateEffectiveDate	3/13/2023
CertificateExpirationDate	3/12/2025
FacilityType	Waiver

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