MEDICARE: CLINICAL DX OF MESA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1134072713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL DX OF MESA LLC

Provider Business Mailing Address
First Line	:	840 W UNIVERSITY DR STE 6
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-5529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 W UNIVERSITY DR STE 6
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-5529
Country	:	US
Telephone Number	:	213-476-9779
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER ROMAN CORONA
Credential	:
Telephone Number	:	213-476-9779

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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