Waterford DX LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

WATERFORD DX LLC

Practice address

6830 N 55TH Ave Ste 100
Glendale, AZ 85301-3304

Phone

(602) 774-2097

NPI assigned

Feb 8, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Frank Affinito

Title

Owner

Phone

(310) 503-9177

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735171200000",
    "number": "1679337802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6830 N 55TH AVE STE 100",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853013304",
            "telephone_number": "602-774-2097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6830 N 55TH AVE STE 100",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853013304",
            "telephone_number": "602-774-2097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD DX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-08",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A",
        "authorized_official_last_name": "AFFINITO",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-503-9177",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quinyatta Shaleish Washington
• Kayla Renee Washom
• Diedrich Wasserbauer
• Sarah Alicia Wasson
• Mark A Wasylenko, MD
• Kate McBride Watkins Judd, PT
• Gary Lynn Watkins, DDS
• Haywood Watkins
• Vicey Watkins
• Gary Watson

• Clinical Medical Laboratory in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Clinical Medical Laboratory in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.