32D2027496 CLIA NUMBER - OMNI MEDICAL GROUP LLC DBA CLINICA LA ESPERANZA

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Laboratory Demographics

CLIA Number: 32D2027496

Facility Name: OMNI MEDICAL GROUP LLC DBA CLINICA LA ESPERANZA

Facility Address:
4201 CENTRAL AVE NW SUITE K3
ALBUQUERQUE, NM
ZIP 87105
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Facility Phone Number: 505 508-1739

Facility Type: Practitioner Other

Certificate Type: Microscopy

NPI Number: 1568768042

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	32D2027496
LAB Type	Practitioner Other
Facility Name	OMNI MEDICAL GROUP LLC DBA CLINICA LA ESPERANZA
Street	4201 CENTRAL AVE NW SUITE K3
City	ALBUQUERQUE
State	NM
ZIP	87105
Phone	505 508-1739
CertificateType	3
CertificateEffectiveDate	7/26/2023
CertificateExpirationDate	7/25/2025
FacilityType	PPMP

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