32D1084754 CLIA NUMBER - SAN MIGUEL HOSPITAL CORP DBA LAS VEGAS MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 32D1084754
  • Facility Name: SAN MIGUEL HOSPITAL CORP DBA LAS VEGAS MEDICAL GROUP
  • Facility Address: 108 LEGION DRIVE STE A ATTN ANNETTE HERNANDEZ
    LAS VEGAS, NM
    ZIP 87701
  • Facility Phone: 505 454-0322
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. RAYMOND ORTIZ
  • NPI Number: 1306233846
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 32D1084754
LAB Type Physician Office
Facility Name SAN MIGUEL HOSPITAL CORP DBA LAS VEGAS MEDICAL GROUP
Street 108 LEGION DRIVE STE A ATTN ANNETTE HERNANDEZ
City LAS VEGAS
State NM
ZIP 87701
Phone 505 454-0322
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2024
Certificate Expiration Date 6/2/2026
Facility Type Physician Office
Lab Director DR. RAYMOND ORTIZ

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