10D2030548 CLIA NUMBER - LAKE VISTA DIALYSIS

Laboratory Demographics

  • CLIA Code: 10D2030548
  • Facility Name: LAKE VISTA DIALYSIS
  • Facility Address: 3187 US HWY 98 N
    LAKELAND, FL
    ZIP 33805
  • Facility Phone: 863 603-2130
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JOSE J. AGUAYO
  • NPI Number: 1295021095
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2030548
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAKE VISTA DIALYSIS
Street 3187 US HWY 98 N
City LAKELAND
State FL
ZIP 33805
Phone 863 603-2130
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/29/2025
Certificate Expiration Date 9/28/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JOSE J. AGUAYO

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