32D2041003 CLIA NUMBER - ANGEL FIRE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 32D2041003
  • Facility Name: ANGEL FIRE PRIMARY CARE
  • Facility Address: 37 ASPEN
    ANGEL FIRE, NM
    ZIP 87710
  • Facility Phone: 575 377-1805
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LESA D. FRAKER
  • NPI Number: 1922376896
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 32D2041003
LAB Type Physician Office
Facility Name ANGEL FIRE PRIMARY CARE
Street 37 ASPEN
City ANGEL FIRE
State NM
ZIP 87710
Phone 575 377-1805
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2024
Certificate Expiration Date 5/14/2026
Facility Type Physician Office
Lab Director LESA D. FRAKER

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