65D2170458 CLIA NUMBER - EVERGREEN HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 65D2170458
  • Facility Name: EVERGREEN HEALTH CENTER
  • Facility Address: 520 ROUTE 8
    AGANA, GU
    ZIP 96910
  • Facility Phone: 671 922-0118
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: OUHADI FARAZ
  • NPI Number: 1972076792
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 65D2170458
LAB Type Community Clinic
Facility Name EVERGREEN HEALTH CENTER
Street 520 ROUTE 8
City AGANA
State GU
ZIP 96910
Phone 671 922-0118
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2025
Certificate Expiration Date 8/11/2027
Facility Type Community Clinic
Lab Director OUHADI FARAZ

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