45D2280294 CLIA NUMBER - CORPUS CHRISTI INTEGRATIVE CLINIC

Laboratory Demographics

CLIA Number: 45D2280294

Facility Name: CORPUS CHRISTI INTEGRATIVE CLINIC

Facility Address:
400 MAIN STREET SUITE 107
CORPUS CHRISTI, TX
ZIP 78401
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Facility Phone Number: 361 257-1711

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1336857796

Taxonomy: 261QI0500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2280294
LAB Type	Physician Office
Facility Name	CORPUS CHRISTI INTEGRATIVE CLINIC
Street	400 MAIN STREET SUITE 107
City	CORPUS CHRISTI
State	TX
ZIP	78401
Phone	361 257-1711
CertificateType	4
CertificateEffectiveDate	4/17/2023
CertificateExpirationDate	4/16/2025
FacilityType	Waiver

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