32D2315137 CLIA NUMBER - RUSTIC HEALTH DIAGNOSTICS LLC

Laboratory Demographics

  • CLIA Code: 32D2315137
  • Facility Name: RUSTIC HEALTH DIAGNOSTICS LLC
  • Facility Address: 405 N DATE SUITE 4
    T OR C, NM
    ZIP 87901
  • Facility Phone: 575 297-4993
  • Facility Type: Other - INDEPENDENT/MOBILE
  • Facility Type: Waiver
  • Lab Director: DAVID J. DONAVAN
  • NPI Number: 1215649629
  • Taxonomy: 253Z00000X - In Home Supportive Care

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CLIA Record

Field Name Field Value
CLIA Number 32D2315137
LAB Type Other - INDEPENDENT/MOBILE
Facility Name RUSTIC HEALTH DIAGNOSTICS LLC
Street 405 N DATE SUITE 4
City T OR C
State NM
ZIP 87901
Phone 575 297-4993
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/6/2024
Certificate Expiration Date 12/5/2026
Facility Type Other - INDEPENDENT/MOBILE
Lab Director DAVID J. DONAVAN

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