10D1091775 CLIA NUMBER - LAURELLWOOD FL OPCO, LLC

Laboratory Demographics

  • CLIA Code: 10D1091775
  • Facility Name: LAURELLWOOD FL OPCO, LLC
  • Facility Address: 3127 57TH AVE N
    SAINT PETERSBURG, FL
    ZIP 33714
  • Facility Phone: 727 527-2171
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: LUIS YCAZA
  • NPI Number: 1407355084
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D1091775
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name LAURELLWOOD FL OPCO, LLC
Street 3127 57TH AVE N
City SAINT PETERSBURG
State FL
ZIP 33714
Phone 727 527-2171
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/10/2024
Certificate Expiration Date 11/9/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director LUIS YCAZA

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