10D2018099 CLIA NUMBER - MD AND WELLNESS CENTER INC

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Laboratory Demographics

CLIA Number: 10D2018099

Facility Name: MD AND WELLNESS CENTER INC

Facility Address:
4600 N HABANA AVE STE 12
TAMPA, FL
ZIP 33614
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Facility Phone Number: 813 876-7700

Facility Type: Other - WELLNESS CENTER

Certificate Type: Waiver

NPI Number: 1922342906

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2018099
LAB Type	Other - WELLNESS CENTER
Facility Name	MD AND WELLNESS CENTER INC
Street	4600 N HABANA AVE STE 12
City	TAMPA
State	FL
ZIP	33614
Phone	813 876-7700
CertificateType	4
CertificateEffectiveDate	12/23/2022
CertificateExpirationDate	12/22/2024
FacilityType	Waiver

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