10D1071939 CLIA NUMBER - ORMOND MEDICAL ARTS FAMILY PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 10D1071939
  • Facility Name: ORMOND MEDICAL ARTS FAMILY PRACTICE LLC
  • Facility Address: 2582 S VOLUSIA AVE
    ORANGE CITY, FL
    ZIP 32763
  • Facility Phone: 386 960-2009
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAJ KANDAVANAM
  • NPI Number: 1255154076
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 10D1071939
LAB Type Physician Office
Facility Name ORMOND MEDICAL ARTS FAMILY PRACTICE LLC
Street 2582 S VOLUSIA AVE
City ORANGE CITY
State FL
ZIP 32763
Phone 386 960-2009
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/25/2024
Certificate Expiration Date 2/24/2026
Facility Type Physician Office
Lab Director RAJ KANDAVANAM

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