32D2178327 CLIA NUMBER - ORTEGA WELLNESS LLC

Laboratory Demographics

CLIA Number: 32D2178327

Facility Name: ORTEGA WELLNESS LLC

Facility Address:
7007 JEFFERSON ST NE UNIT 3
ALBUQUERQUE, NM
ZIP 87109
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Facility Phone Number: 505 350-0406

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1013464379

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	32D2178327
LAB Type	Practitioner Other
Facility Name	ORTEGA WELLNESS LLC
Street	7007 JEFFERSON ST NE UNIT 3
City	ALBUQUERQUE
State	NM
ZIP	87109
Phone	505 350-0406
CertificateType	4
CertificateEffectiveDate	1/30/2024
CertificateExpirationDate	1/29/2026
FacilityType	Waiver

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