45D2164283 CLIA NUMBER - VICTOR O MENDIOLA

Laboratory Demographics

CLIA Number: 45D2164283

Facility Name: VICTOR O MENDIOLA

Facility Address:
427 WEST 20TH SUITE 201
HOUSTON, TX
ZIP 77008
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Facility Phone Number: 713 697-4705

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1639380595

Taxonomy: 1223P0221X - Dentist
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

CLIA Record

Field Name	Field Value
CLIA Number	45D2164283
LAB Type	Physician Office
Facility Name	VICTOR O MENDIOLA
Street	427 WEST 20TH SUITE 201
City	HOUSTON
State	TX
ZIP	77008
Phone	713 697-4705
CertificateType	4
CertificateEffectiveDate	4/2/2023
CertificateExpirationDate	4/1/2025
FacilityType	Waiver

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