10D0966089 CLIA NUMBER - ADVANCED DERMATOLOGY AND COSMETIC SURGERY

Laboratory Demographics

  • CLIA Code: 10D0966089
  • Facility Name: ADVANCED DERMATOLOGY AND COSMETIC SURGERY
  • Facility Address: 200 SOUTHPARK BLVD STE 207
    ST AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 407 284-3407
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. JUAN CARLOS MARTINEZ
  • NPI Number: 1932557451
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 10D0966089
LAB Type Physician Office
Facility Name ADVANCED DERMATOLOGY AND COSMETIC SURGERY
Street 200 SOUTHPARK BLVD STE 207
City ST AUGUSTINE
State FL
ZIP 32086
Phone 407 284-3407
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 1/20/2024
Certificate Expiration Date 1/19/2026
Facility Type Physician Office
Lab Director DR. JUAN CARLOS MARTINEZ

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