32D2325550 CLIA NUMBER - JICARILLA SERVICES UNIT

Laboratory Demographics

CLIA Code: 32D2325550
Facility Name: JICARILLA SERVICES UNIT
Facility Address: 500 N MUNDO / P O BOX 187
DULCE, NM
ZIP 87528
Facility Phone: 575 759-3291
Facility Type: Ancillary Testing Site in Health Care Center
Facility Type: Waiver
Lab Director: CECILLIA CHAO
NPI Number: 1124220900
Taxonomy: 332800000X - Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy

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CLIA Record

Field Name	Field Value
CLIA Number	32D2325550
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	JICARILLA SERVICES UNIT
Street	500 N MUNDO / P O BOX 187
City	DULCE
State	NM
ZIP	87528
Phone	575 759-3291
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/16/2025
Certificate Expiration Date	6/15/2027
Facility Type	Ancillary Testing Site in Health Care Center
Lab Director	CECILLIA CHAO

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