32D0535872 CLIA NUMBER - PEDIATRICS FAMILY PRACTICE AND INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 32D0535872
  • Facility Name: PEDIATRICS FAMILY PRACTICE AND INTERNAL MEDICINE
  • Facility Address: 4005 HIGH RESORT BLVD
    RIO RANCHO, NM
    ZIP 87124
  • Facility Phone: 505 462-8225
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SIMONE GREEN
  • NPI Number: 1316391840
  • Taxonomy: 103K00000X - Behavior Analyst

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CLIA Record

Field Name Field Value
CLIA Number 32D0535872
LAB Type Physician Office
Facility Name PEDIATRICS FAMILY PRACTICE AND INTERNAL MEDICINE
Street 4005 HIGH RESORT BLVD
City RIO RANCHO
State NM
ZIP 87124
Phone 505 462-8225
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2023
Certificate Expiration Date 10/15/2025
Facility Type Physician Office
Lab Director SIMONE GREEN

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