10D0942543 CLIA NUMBER - CARLOS DOMINQUEZ MD PA

Laboratory Demographics

  • CLIA Code: 10D0942543
  • Facility Name: CARLOS DOMINQUEZ MD PA
  • Facility Address: 1857 PROVIDENCE BOULEVARD
    DELTONA, FL
    ZIP 32725
  • Facility Phone: 386 789-3035
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CARLOS DOMINQUEZ
  • NPI Number: 1104864768
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0942543
LAB Type Physician Office
Facility Name CARLOS DOMINQUEZ MD PA
Street 1857 PROVIDENCE BOULEVARD
City DELTONA
State FL
ZIP 32725
Phone 386 789-3035
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/13/2024
Certificate Expiration Date 3/12/2026
Facility Type Physician Office
Lab Director CARLOS DOMINQUEZ

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