32D2019114 CLIA NUMBER - ESPANOLA VA CBOC

Laboratory Demographics

  • CLIA Code: 32D2019114
  • Facility Name: ESPANOLA VA CBOC
  • Facility Address: 110 NORTH CORONADO
    ESPANOLA, NM
    ZIP 87532
  • Facility Phone: 469 634-1800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL RYAN BRISON
  • NPI Number: 1841365699
  • Taxonomy: 235Z00000X - Speech-Language Pathologist

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CLIA Record

Field Name Field Value
CLIA Number 32D2019114
LAB Type Physician Office
Facility Name ESPANOLA VA CBOC
Street 110 NORTH CORONADO
City ESPANOLA
State NM
ZIP 87532
Phone 469 634-1800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2025
Certificate Expiration Date 1/23/2027
Facility Type Physician Office
Lab Director MICHAEL RYAN BRISON

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