52D2330344 CLIA NUMBER - BLUE HORIZEN WELLNESS LLC

Laboratory Demographics

  • CLIA Code: 52D2330344
  • Facility Name: BLUE HORIZEN WELLNESS LLC
  • Facility Address: 3333 SUNNYSLOPE RD, SUITE 108
    NEW BERLIN, WI
    ZIP 53151
  • Facility Phone: 909 266-3404
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DR. MARYAM SHITTU
  • NPI Number: 1518857416
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 52D2330344
LAB Type Practitioner Other
Facility Name BLUE HORIZEN WELLNESS LLC
Street 3333 SUNNYSLOPE RD, SUITE 108
City NEW BERLIN
State WI
ZIP 53151
Phone 909 266-3404
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/15/2025
Certificate Expiration Date 9/14/2027
Facility Type Practitioner Other
Lab Director DR. MARYAM SHITTU

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