10D1020174 CLIA NUMBER - PET IMAGING INSTITUTE OF SOUTH FLORIDA WEST

Laboratory Demographics

  • CLIA Code: 10D1020174
  • Facility Name: PET IMAGING INSTITUTE OF SOUTH FLORIDA WEST
  • Facility Address: 603 N FLAMINGO RD S155
    PEMBROKE PINES, FL
    ZIP 33028
  • Facility Phone: 954 981-6668
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: BARBARA RAPHAEL
  • NPI Number: 1760602510
  • Taxonomy: 261QR0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D1020174
LAB Type Ancillary Testing Site in Health Care Center
Facility Name PET IMAGING INSTITUTE OF SOUTH FLORIDA WEST
Street 603 N FLAMINGO RD S155
City PEMBROKE PINES
State FL
ZIP 33028
Phone 954 981-6668
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2023
Certificate Expiration Date 12/14/2025
Facility Type Ancillary Testing Site in Health Care Center
Lab Director BARBARA RAPHAEL

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