10D2061553 CLIA NUMBER - JIROMA INC

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Laboratory Demographics

CLIA Number: 10D2061553

Facility Name: JIROMA INC

Facility Address:
455 EDGEWOOD AVE S
JACKSONVILLE, FL
ZIP 32205
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Facility Phone Number: 904 384-9007

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1265749428

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2061553
LAB Type	Physician Office
Facility Name	JIROMA INC
Street	455 EDGEWOOD AVE S
City	JACKSONVILLE
State	FL
ZIP	32205
Phone	904 384-9007
CertificateType	4
CertificateEffectiveDate	12/21/2022
CertificateExpirationDate	12/20/2024
FacilityType	Waiver

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