32D2116788 CLIA NUMBER - PECOS VALLEY WELLNESS LLC

Laboratory Demographics

CLIA Number: 32D2116788

Facility Name: PECOS VALLEY WELLNESS LLC

Facility Address:
404B WEST COLLEGE BLVD
ROSWELL, NM
ZIP 88201
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Facility Phone Number: 575 691-9814

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1407382567

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	32D2116788
LAB Type	Practitioner Other
Facility Name	PECOS VALLEY WELLNESS LLC
Street	404B WEST COLLEGE BLVD
City	ROSWELL
State	NM
ZIP	88201
Phone	575 691-9814
CertificateType	4
CertificateEffectiveDate	8/2/2022
CertificateExpirationDate	8/1/2024
FacilityType	Waiver

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