10D0996766 CLIA NUMBER - ICONIC HEALTH, LLC

Laboratory Demographics

  • CLIA Code: 10D0996766
  • Facility Name: ICONIC HEALTH, LLC
  • Facility Address: 1898 W HILLSBORO BLVD SUITE H
    DEERFIELD BEACH, FL
    ZIP 33442
  • Facility Phone: 954 571-9392
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SARAH O. RAVELLI
  • NPI Number: 1700460383
  • Taxonomy: 363LA2200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D0996766
LAB Type Physician Office
Facility Name ICONIC HEALTH, LLC
Street 1898 W HILLSBORO BLVD SUITE H
City DEERFIELD BEACH
State FL
ZIP 33442
Phone 954 571-9392
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2024
Certificate Expiration Date 2/26/2026
Facility Type Physician Office
Lab Director SARAH O. RAVELLI

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