10D0722985 CLIA NUMBER - ADVANCED DERMATOLOGY AND COSMETIC SURGERY

Laboratory Demographics

CLIA Number: 10D0722985

Facility Name: ADVANCED DERMATOLOGY AND COSMETIC SURGERY

Facility Address:
1893 KINGSLEY AVENUE
ORANGE PARK, FL
ZIP 32073
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Facility Phone Number: 407 284-3407

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1871879841

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	10D0722985
LAB Type	Physician Office
Facility Name	ADVANCED DERMATOLOGY AND COSMETIC SURGERY
Street	1893 KINGSLEY AVENUE
City	ORANGE PARK
State	FL
ZIP	32073
Phone	407 284-3407
CertificateType	2
CertificateEffectiveDate	2/14/2024
CertificateExpirationDate	2/13/2026
FacilityType	Compliance

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This page was last updated on: 4/23/2024