45D0704215 CLIA NUMBER - SPENCE LEGACY FAMILY CLINIC

Laboratory Demographics

  • CLIA Code: 45D0704215
  • Facility Name: SPENCE LEGACY FAMILY CLINIC
  • Facility Address: 336 SOUTH 8TH STREET
    RAYMONDVILLE, TX
    ZIP 78580
  • Facility Phone: 956 689-2456
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MARIO LUIS VASQUEZ AGUILAR
  • NPI Number: 1629741558
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D0704215
LAB Type Physician Office
Facility Name SPENCE LEGACY FAMILY CLINIC
Street 336 SOUTH 8TH STREET
City RAYMONDVILLE
State TX
ZIP 78580
Phone 956 689-2456
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Physician Office
Lab Director DR. MARIO LUIS VASQUEZ AGUILAR

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