10D1056592 CLIA NUMBER - CAPE CORAL SOUTH DIALYSIS

Laboratory Demographics

CLIA Number: 10D1056592

Facility Name: CAPE CORAL SOUTH DIALYSIS

Facility Address:
3040 DEL PRADO BLVD SOUTH
CAPE CORAL, FL
ZIP 33904
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Facility Phone Number: 239 549-0339

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1962421131

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1056592
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	CAPE CORAL SOUTH DIALYSIS
Street	3040 DEL PRADO BLVD SOUTH
City	CAPE CORAL
State	FL
ZIP	33904
Phone	239 549-0339
CertificateType	4
CertificateEffectiveDate	7/20/2022
CertificateExpirationDate	7/19/2024
FacilityType	Waiver

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