45D2148686 CLIA NUMBER - ESSENCIA FAMILY PRACTICE & IMMEDIATE CARE CLINIC

Laboratory Demographics

  • CLIA Code: 45D2148686
  • Facility Name: ESSENCIA FAMILY PRACTICE & IMMEDIATE CARE CLINIC
  • Facility Address: 1509 W HEBRON PKWY SUITE 140
    CARROLLTON, TX
    ZIP 75010
  • Facility Phone: 972 306-0016
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: OLUSESAN O. OLOTU
  • NPI Number: 1013407451
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2148686
LAB Type Physician Office
Facility Name ESSENCIA FAMILY PRACTICE & IMMEDIATE CARE CLINIC
Street 1509 W HEBRON PKWY SUITE 140
City CARROLLTON
State TX
ZIP 75010
Phone 972 306-0016
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2024
Certificate Expiration Date 5/15/2026
Facility Type Physician Office
Lab Director OLUSESAN O. OLOTU

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