10D0968096 CLIA NUMBER - MEDICAL HOME ALLIANCE, LLC DBA IMA MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 10D0968096
  • Facility Name: MEDICAL HOME ALLIANCE, LLC DBA IMA MEDICAL GROUP
  • Facility Address: 181 WEBB DR STE A
    DAVENPORT, FL
    ZIP 33837
  • Facility Phone: 863 419-1235
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ISMAEL RUIZ DE LA ROSA
  • NPI Number: 1902802572
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0968096
LAB Type Physician Office
Facility Name MEDICAL HOME ALLIANCE, LLC DBA IMA MEDICAL GROUP
Street 181 WEBB DR STE A
City DAVENPORT
State FL
ZIP 33837
Phone 863 419-1235
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/17/2024
Certificate Expiration Date 2/16/2026
Facility Type Physician Office
Lab Director ISMAEL RUIZ DE LA ROSA

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