32D2206342 CLIA NUMBER - PASSPORT HEALTH NEW MEXICO

Laboratory Demographics

  • CLIA Code: 32D2206342
  • Facility Name: PASSPORT HEALTH NEW MEXICO
  • Facility Address: 1717 LOUISIANA BLVD NE SUITE 212
    ALBUQUERQUE, NM
    ZIP 87110
  • Facility Phone: 505 881-8785
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. IRENE AGOSTINI
  • NPI Number: 1982825667
  • Taxonomy: 261QX0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 32D2206342
LAB Type Physician Office
Facility Name PASSPORT HEALTH NEW MEXICO
Street 1717 LOUISIANA BLVD NE SUITE 212
City ALBUQUERQUE
State NM
ZIP 87110
Phone 505 881-8785
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2024
Certificate Expiration Date 12/17/2026
Facility Type Physician Office
Lab Director DR. IRENE AGOSTINI

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