32D2096773 CLIA NUMBER - SANTA TERESA CHILDREN'S NIGHT CLINIC

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Laboratory Demographics

CLIA Number: 32D2096773

Facility Name: SANTA TERESA CHILDREN'S NIGHT CLINIC

Facility Address:
1245 COUNTRY CLUB ROAD SUITE 200
SANTA TERESA, NM
ZIP 88008
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Facility Phone Number: 575 332-4633

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1720469679

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	32D2096773
LAB Type	Practitioner Other
Facility Name	SANTA TERESA CHILDREN'S NIGHT CLINIC
Street	1245 COUNTRY CLUB ROAD SUITE 200
City	SANTA TERESA
State	NM
ZIP	88008
Phone	575 332-4633
CertificateType	4
CertificateEffectiveDate	6/1/2023
CertificateExpirationDate	5/31/2025
FacilityType	Waiver

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