10D1004978 CLIA NUMBER - CORNERSTONE MEDICAL CARE OF BRANDON, LLC

Laboratory Demographics

CLIA Number: 10D1004978

Facility Name: CORNERSTONE MEDICAL CARE OF BRANDON, LLC

Facility Address:
500 VONDERERG DR #101-102E
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 681-5658

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1124038989

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1004978
LAB Type	Physician Office
Facility Name	CORNERSTONE MEDICAL CARE OF BRANDON, LLC
Street	500 VONDERERG DR #101-102E
City	BRANDON
State	FL
ZIP	33511
Phone	813 681-5658
CertificateType	4
CertificateEffectiveDate	10/10/2022
CertificateExpirationDate	10/9/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024