32D2031927 CLIA NUMBER - SAN MIGUEL CLINIC CORP DBA LAS VEGAS MEDICAL GROUP PEDIATRICS

Laboratory Demographics

  • CLIA Code: 32D2031927
  • Facility Name: SAN MIGUEL CLINIC CORP DBA LAS VEGAS MEDICAL GROUP PEDIATRICS
  • Facility Address: 108 LEGION DRIVE SUITE C
    LAS VEGAS, NM
    ZIP 87701
  • Facility Phone: (505) 425-3566
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBIN EDWARD
  • NPI Number: 1114916319
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 32D2031927
LAB Type Physician Office
Facility Name SAN MIGUEL CLINIC CORP DBA LAS VEGAS MEDICAL GROUP PEDIATRICS
Street 108 LEGION DRIVE SUITE C
City LAS VEGAS
State NM
ZIP 87701
Phone 5054253566
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2025
Certificate Expiration Date 10/30/2027
Facility Type Physician Office
Lab Director ROBIN EDWARD

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This page was last updated on: 5/18/2026