45D2240377 CLIA NUMBER - LAS FUENTES MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 45D2240377
  • Facility Name: LAS FUENTES MEDICAL CLINIC
  • Facility Address: 1400 W GRIFFIN PKWY SUITE 1
    MISSION, TX
    ZIP 78572
  • Facility Phone: 956 997-0106
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERTO M. LOPEZ
  • NPI Number: 1619548104
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D2240377
LAB Type Physician Office
Facility Name LAS FUENTES MEDICAL CLINIC
Street 1400 W GRIFFIN PKWY SUITE 1
City MISSION
State TX
ZIP 78572
Phone 956 997-0106
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2023
Certificate Expiration Date 10/18/2025
Facility Type Physician Office
Lab Director ROBERTO M. LOPEZ

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