45D0663846 CLIA NUMBER - CITY OF LAREDO HEALTH DEPARTMENT WIC PROGRAM

Laboratory Demographics

CLIA Number: 45D0663846

Facility Name: CITY OF LAREDO HEALTH DEPARTMENT WIC PROGRAM

Facility Address:
2600 CEDAR AVE
LAREDO, TX
ZIP 78040
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Facility Phone Number: 956 723-2051

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1790858769

Taxonomy: 261QP0905X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D0663846
LAB Type	Community Clinic
Facility Name	CITY OF LAREDO HEALTH DEPARTMENT WIC PROGRAM
Street	2600 CEDAR AVE
City	LAREDO
State	TX
ZIP	78040
Phone	956 723-2051
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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