32D2298691 CLIA NUMBER - MOUNT SINAI DOCTORS WEIGHT LOSS CENTER LLC

Laboratory Demographics

CLIA Number: 32D2298691

Facility Name: MOUNT SINAI DOCTORS WEIGHT LOSS CENTER LLC

Facility Address:
8500 MENAUL BLVD SUITE B550
ALBUQUERQUE, NM
ZIP 87112
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Facility Phone Number: 505 595-3113

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1477316552

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	32D2298691
LAB Type	Physician Office
Facility Name	MOUNT SINAI DOCTORS WEIGHT LOSS CENTER LLC
Street	8500 MENAUL BLVD SUITE B550
City	ALBUQUERQUE
State	NM
ZIP	87112
Phone	505 595-3113
CertificateType	4
CertificateEffectiveDate	2/7/2024
CertificateExpirationDate	2/6/2026
FacilityType	Waiver

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