45D2099688 CLIA NUMBER - PSJA FAMILY CLINIC LC

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Laboratory Demographics

CLIA Number: 45D2099688

Facility Name: PSJA FAMILY CLINIC LC

Facility Address:
1536 S CAGE BLVD, SUITE 5
PHARR, TX
ZIP 78577
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Facility Phone Number: 956 781-8396

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1447631841

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	45D2099688
LAB Type	Physician Office
Facility Name	PSJA FAMILY CLINIC LC
Street	1536 S CAGE BLVD, SUITE 5
City	PHARR
State	TX
ZIP	78577
Phone	956 781-8396
CertificateType	4
CertificateEffectiveDate	7/30/2023
CertificateExpirationDate	7/29/2025
FacilityType	Waiver

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