10D1035171 CLIA NUMBER - SPACE COAST UROLOGY LLC

Laboratory Demographics

  • CLIA Code: 10D1035171
  • Facility Name: SPACE COAST UROLOGY LLC
  • Facility Address: 4420 S HOPKINS AVE
    TITUSVILLE, FL
    ZIP 32780
  • Facility Phone: 321 268-4693
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JUSTO GONZALEZ
  • NPI Number: 1336337690
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 10D1035171
LAB Type Physician Office
Facility Name SPACE COAST UROLOGY LLC
Street 4420 S HOPKINS AVE
City TITUSVILLE
State FL
ZIP 32780
Phone 321 268-4693
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2024
Certificate Expiration Date 12/21/2026
Facility Type Physician Office
Lab Director JUSTO GONZALEZ

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