10D1104949 CLIA NUMBER - AQUA DERMATOLOGY OF FLORIDA PA

Laboratory Demographics

CLIA Number: 10D1104949

Facility Name: AQUA DERMATOLOGY OF FLORIDA PA

Facility Address:
413 DEL PRADO BLVD S STE 101
CAPE CORAL, FL
ZIP 33990
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Facility Phone Number: 941 356-3766

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1538645775

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	10D1104949
LAB Type	Physician Office
Facility Name	AQUA DERMATOLOGY OF FLORIDA PA
Street	413 DEL PRADO BLVD S STE 101
City	CAPE CORAL
State	FL
ZIP	33990
Phone	941 356-3766
CertificateType	2
CertificateEffectiveDate	11/6/2023
CertificateExpirationDate	11/5/2025
FacilityType	Compliance

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