10D0294616 CLIA NUMBER - DAVID S BALLESTAS MD

Laboratory Demographics

  • CLIA Code: 10D0294616
  • Facility Name: DAVID S BALLESTAS MD
  • Facility Address: 2525 HARBOR BLVD # 102
    PORT CHARLOTTE, FL
    ZIP 33952
  • Facility Phone: 941 629-9190
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID S. BALLESTAS MD
  • NPI Number: 1609969419
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0294616
LAB Type Physician Office
Facility Name DAVID S BALLESTAS MD
Street 2525 HARBOR BLVD # 102
City PORT CHARLOTTE
State FL
ZIP 33952
Phone 941 629-9190
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2024
Certificate Expiration Date 8/25/2026
Facility Type Physician Office
Lab Director DAVID S. BALLESTAS MD

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