29D2241417 CLIA NUMBER - MODERN WELLNESS CLINIC

Laboratory Demographics

  • CLIA Code: 29D2241417
  • Facility Name: MODERN WELLNESS CLINIC
  • Facility Address: 5375 S FORT APACHE RD STES 102-103
    LAS VEGAS, NV
    ZIP 89148
  • Facility Phone: 702 463-9159
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TRI TRUONG
  • NPI Number: 1245801273
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 29D2241417
LAB Type Physician Office
Facility Name MODERN WELLNESS CLINIC
Street 5375 S FORT APACHE RD STES 102-103
City LAS VEGAS
State NV
ZIP 89148
Phone 702 463-9159
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/28/2023
Certificate Expiration Date 10/27/2025
Facility Type Physician Office
Lab Director TRI TRUONG

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