45D0879166 CLIA NUMBER - CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, P A DBA CONVIVA CARE CENTER

Laboratory Demographics

  • CLIA Code: 45D0879166
  • Facility Name: CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, P A DBA CONVIVA CARE CENTER
  • Facility Address: 1105 OAK STREET, SUITE A
    JOURDANTON, TX
    ZIP 78026
  • Facility Phone: 830 769-2181
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JACQUELIN E. CASTILLO
  • NPI Number: 1407934797
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D0879166
LAB Type Physician Office
Facility Name CONVIVA MEDICAL CENTER MANAGEMENT OF TEXAS, P A DBA CONVIVA CARE CENTER
Street 1105 OAK STREET, SUITE A
City JOURDANTON
State TX
ZIP 78026
Phone 830 769-2181
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2024
Certificate Expiration Date 6/7/2026
Facility Type Physician Office
Lab Director JACQUELIN E. CASTILLO

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