10D2055180 CLIA NUMBER - GUTIERREZ MEDICAL CENTER

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Laboratory Demographics

CLIA Number: 10D2055180

Facility Name: GUTIERREZ MEDICAL CENTER

Facility Address:
5804 LAKE UNDERHILL RD STE A
ORLANDO, FL
ZIP 32807
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Facility Phone Number: 407 203-6898

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1750729075

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2055180
LAB Type	Physician Office
Facility Name	GUTIERREZ MEDICAL CENTER
Street	5804 LAKE UNDERHILL RD STE A
City	ORLANDO
State	FL
ZIP	32807
Phone	407 203-6898
CertificateType	4
CertificateEffectiveDate	3/6/2023
CertificateExpirationDate	3/5/2025
FacilityType	Waiver

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