10D2004149 CLIA NUMBER - WELLNESS CLINIC OF BRANDON, LLC

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Laboratory Demographics

CLIA Number: 10D2004149

Facility Name: WELLNESS CLINIC OF BRANDON, LLC

Facility Address:
203 W BLOOMINGDALE AVE
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 654-1110

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1245576685

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2004149
LAB Type	Practitioner Other
Facility Name	WELLNESS CLINIC OF BRANDON, LLC
Street	203 W BLOOMINGDALE AVE
City	BRANDON
State	FL
ZIP	33511
Phone	813 654-1110
CertificateType	4
CertificateEffectiveDate	2/26/2024
CertificateExpirationDate	2/25/2026
FacilityType	Waiver

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