10D1101005 CLIA NUMBER - INDIAN RIVER INTERNAL MEDICINE

Laboratory Demographics

  • CLIA Code: 10D1101005
  • Facility Name: INDIAN RIVER INTERNAL MEDICINE
  • Facility Address: 7935 BAY ST SUITE 3
    SEBASTIAN, FL
    ZIP 32958
  • Facility Phone: 772 581-1881
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ENIO PRIETO
  • NPI Number: 1811136773
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D1101005
LAB Type Physician Office
Facility Name INDIAN RIVER INTERNAL MEDICINE
Street 7935 BAY ST SUITE 3
City SEBASTIAN
State FL
ZIP 32958
Phone 772 581-1881
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/18/2025
Certificate Expiration Date 6/17/2027
Facility Type Physician Office
Lab Director ENIO PRIETO

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