10D0943818 CLIA NUMBER - BASIL MANGRA MD PA DBA LAUDERDALE LAKES MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 10D0943818
  • Facility Name: BASIL MANGRA MD PA DBA LAUDERDALE LAKES MEDICAL CENTER
  • Facility Address: 4357 NORTH STATE ROAD 7
    LAUDERDALE LAKES, FL
    ZIP 33319
  • Facility Phone: 954 484-6440
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KAMINIE RAMAUTER
  • NPI Number: 1114913688
  • Taxonomy: 173000000X - Legal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0943818
LAB Type Physician Office
Facility Name BASIL MANGRA MD PA DBA LAUDERDALE LAKES MEDICAL CENTER
Street 4357 NORTH STATE ROAD 7
City LAUDERDALE LAKES
State FL
ZIP 33319
Phone 954 484-6440
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2025
Certificate Expiration Date 3/11/2027
Facility Type Physician Office
Lab Director KAMINIE RAMAUTER

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