45D2268374 CLIA NUMBER - CLINICA HISPANA DEL METROPLEX

Laboratory Demographics

CLIA Number: 45D2268374

Facility Name: CLINICA HISPANA DEL METROPLEX

Facility Address:
2741 ELLIS AVE
FORT WORTH, TX
ZIP 76164
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Facility Phone Number: 817 386-9926

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1912655721

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2268374
LAB Type	Physician Office
Facility Name	CLINICA HISPANA DEL METROPLEX
Street	2741 ELLIS AVE
City	FORT WORTH
State	TX
ZIP	76164
Phone	817 386-9926
CertificateType	4
CertificateEffectiveDate	9/9/2022
CertificateExpirationDate	9/8/2024
FacilityType	Waiver

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