07D2116496 CLIA NUMBER - SOUTHEASTERN CT PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 07D2116496
  • Facility Name: SOUTHEASTERN CT PRIMARY CARE, LLC
  • Facility Address: 10 LIBERTY WAY, STE 10B
    NIANTIC, CT
    ZIP 06357
  • Facility Phone: 860 691-8084
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROSALINDA GAONA
  • NPI Number: 1134591696
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 07D2116496
LAB Type Physician Office
Facility Name SOUTHEASTERN CT PRIMARY CARE, LLC
Street 10 LIBERTY WAY, STE 10B
City NIANTIC
State CT
ZIP 06357
Phone 860 691-8084
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/27/2024
Certificate Expiration Date 7/26/2026
Facility Type Physician Office
Lab Director ROSALINDA GAONA

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