45D2308007 CLIA NUMBER - EP MODERN MEDICINE PLLC DBA EP PREVENTATIVE CARE

Laboratory Demographics

  • CLIA Code: 45D2308007
  • Facility Name: EP MODERN MEDICINE PLLC DBA EP PREVENTATIVE CARE
  • Facility Address: 154 N FESTIVAL DR. STE A
    EL PASO, TX
    ZIP 79912
  • Facility Phone: (915) 328-6233
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIBEL MAGALLANES
  • NPI Number: 1417723693
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 45D2308007
LAB Type Physician Office
Facility Name EP MODERN MEDICINE PLLC DBA EP PREVENTATIVE CARE
Street 154 N FESTIVAL DR. STE A
City EL PASO
State TX
ZIP 79912
Phone 9153286233
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2026
Certificate Expiration Date 7/17/2028
Facility Type Physician Office
Lab Director MARIBEL MAGALLANES

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This page was last updated on: 6/29/2026