10D1100832 CLIA NUMBER - COLLIER HMA PHYSICIAN MANAGEMENT LLC

Laboratory Demographics

  • CLIA Code: 10D1100832
  • Facility Name: COLLIER HMA PHYSICIAN MANAGEMENT LLC
  • Facility Address: 24231 WALDEN CENTER DR STE 100
    BONITA SPRINGS, FL
    ZIP 34134
  • Facility Phone: 239 354-4590
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RODOLFO FERNANDEZ
  • NPI Number: 1164090874
  • Taxonomy: 208VP0000X - Pain Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D1100832
LAB Type Physician Office
Facility Name COLLIER HMA PHYSICIAN MANAGEMENT LLC
Street 24231 WALDEN CENTER DR STE 100
City BONITA SPRINGS
State FL
ZIP 34134
Phone 239 354-4590
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2025
Certificate Expiration Date 6/11/2027
Facility Type Physician Office
Lab Director RODOLFO FERNANDEZ

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