10D0892964 CLIA NUMBER - CONVIVA CARE CENTER

Laboratory Demographics

CLIA Number: 10D0892964

Facility Name: CONVIVA CARE CENTER

Facility Address:
3691 S CLYDE MORRIS BLVD
PORT ORANGE, FL
ZIP 32129
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Facility Phone Number: 386 388-7114

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1134504855

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	10D0892964
LAB Type	Physician Office
Facility Name	CONVIVA CARE CENTER
Street	3691 S CLYDE MORRIS BLVD
City	PORT ORANGE
State	FL
ZIP	32129
Phone	386 388-7114
CertificateType	4
CertificateEffectiveDate	10/12/2022
CertificateExpirationDate	10/11/2024
FacilityType	Waiver

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