10D2039797 CLIA NUMBER - SOUTHSIDE OBGYN PLLC

Laboratory Demographics

  • CLIA Code: 10D2039797
  • Facility Name: SOUTHSIDE OBGYN PLLC
  • Facility Address: 1380 NE MIAMI GARDENS DR STE 138
    NORTH MIAMI BEACH, FL
    ZIP 33179
  • Facility Phone: 786 657-2269
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDY AMISIAL
  • NPI Number: 1427322882
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 10D2039797
LAB Type Physician Office
Facility Name SOUTHSIDE OBGYN PLLC
Street 1380 NE MIAMI GARDENS DR STE 138
City NORTH MIAMI BEACH
State FL
ZIP 33179
Phone 786 657-2269
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/27/2024
Certificate Expiration Date 6/26/2026
Facility Type Physician Office
Lab Director EDY AMISIAL

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