45D0965745 CLIA NUMBER - CENTRO SAN VICENTE

Laboratory Demographics

CLIA Number: 45D0965745

Facility Name: CENTRO SAN VICENTE

Facility Address:
13017 PERICO
SAN ELIZARIO, TX
ZIP 79849
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Facility Phone Number: 915 851-0999

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1780761452

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D0965745
LAB Type	Community Clinic
Facility Name	CENTRO SAN VICENTE
Street	13017 PERICO
City	SAN ELIZARIO
State	TX
ZIP	79849
Phone	915 851-0999
CertificateType	3
CertificateEffectiveDate	7/10/2022
CertificateExpirationDate	7/9/2024
FacilityType	PPMP

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