45D2069296 CLIA NUMBER - FOREST CLINICA FAMILIAR

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Laboratory Demographics

CLIA Number: 45D2069296

Facility Name: FOREST CLINICA FAMILIAR

Facility Address:
9550 FOREST LN STE 606
DALLAS, TX
ZIP 75243
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Facility Phone Number: 469 804-7929

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1982036935

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	45D2069296
LAB Type	Community Clinic
Facility Name	FOREST CLINICA FAMILIAR
Street	9550 FOREST LN STE 606
City	DALLAS
State	TX
ZIP	75243
Phone	469 804-7929
CertificateType	4
CertificateEffectiveDate	11/21/2023
CertificateExpirationDate	11/20/2025
FacilityType	Waiver

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