10D2039878 CLIA NUMBER - ITZHAK NIR MD PA DBA PRESTIGE SURGERY CTR

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Laboratory Demographics

CLIA Number: 10D2039878

Facility Name: ITZHAK NIR MD PA DBA PRESTIGE SURGERY CTR

Facility Address:
13005 SOUTHERN BLVD STE 232
LOXAHATCHEE, FL
ZIP 33470
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Facility Phone Number: 561 753-3331

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1124015482

Taxonomy: 2086S0122X - Surgery
A surgeon who specializes in plastic and reconstructive surgery.

CLIA Record

Field Name	Field Value
CLIA Number	10D2039878
LAB Type	Physician Office
Facility Name	ITZHAK NIR MD PA DBA PRESTIGE SURGERY CTR
Street	13005 SOUTHERN BLVD STE 232
City	LOXAHATCHEE
State	FL
ZIP	33470
Phone	561 753-3331
CertificateType	4
CertificateEffectiveDate	4/18/2024
CertificateExpirationDate	4/17/2026
FacilityType	Waiver

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