10D0673097 CLIA NUMBER - BEACHES DERMATOLOGY PA

Laboratory Demographics

  • CLIA Code: 10D0673097
  • Facility Name: BEACHES DERMATOLOGY PA
  • Facility Address: 103 SOLANA ROAD SUITE B
    PONTE VEDRA BEACH, FL
    ZIP 32082
  • Facility Phone: (904) 273-2717
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLARENCE E. BOUDREAUX
  • NPI Number: 1780627521
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 10D0673097
LAB Type Physician Office
Facility Name BEACHES DERMATOLOGY PA
Street 103 SOLANA ROAD SUITE B
City PONTE VEDRA BEACH
State FL
ZIP 32082
Phone 9042732717
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2025
Certificate Expiration Date 9/9/2027
Facility Type Physician Office
Lab Director CLARENCE E. BOUDREAUX

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This page was last updated on: 6/29/2026