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10D2058104 CLIA NUMBER - CAREVANTAGE MEDICAL CENTERS OF MIAMI AT HIALEAH LL

Laboratory Demographics

CLIA Number: 10D2058104

Facility Name: CAREVANTAGE MEDICAL CENTERS OF MIAMI AT HIALEAH LL

Facility Address:
4445 W 16TH AVE STE 100
HIALEAH, FL
ZIP 33012
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Facility Phone Number: 305 558-8687

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1326592486

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name Field Value
CLIA Number 10D2058104
LAB Type Physician Office
Facility Name CAREVANTAGE MEDICAL CENTERS OF MIAMI AT HIALEAH LL
Street 4445 W 16TH AVE STE 100
City HIALEAH
State FL
ZIP 33012
Phone 305 558-8687
CertificateType 4
CertificateEffectiveDate 4/30/2023
CertificateExpirationDate 4/29/2025
FacilityType Waiver

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