10D1036065 CLIA NUMBER - DAVENPORT DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 10D1036065
  • Facility Name: DAVENPORT DIALYSIS CENTER
  • Facility Address: 45597 HWY 27 RIDGEVIEW PLAZA
    DAVENPORT, FL
    ZIP 33897
  • Facility Phone: 863 419-7408
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: VIRESH MOHANLAL
  • NPI Number: 1669438495
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D1036065
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name DAVENPORT DIALYSIS CENTER
Street 45597 HWY 27 RIDGEVIEW PLAZA
City DAVENPORT
State FL
ZIP 33897
Phone 863 419-7408
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2025
Certificate Expiration Date 1/18/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director VIRESH MOHANLAL

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