10D2062453 CLIA NUMBER - CONVIVA MEDICAL CENTER MANAGEMENT LLC DBA CONVIVA CARE CENTER

Laboratory Demographics

  • CLIA Code: 10D2062453
  • Facility Name: CONVIVA MEDICAL CENTER MANAGEMENT LLC DBA CONVIVA CARE CENTER
  • Facility Address: 480 N STATE RD 7
    PLANTATION, FL
    ZIP 33317
  • Facility Phone: 954 791-9580
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HEROLD J. MERISIER
  • NPI Number: 1851053920
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2062453
LAB Type Physician Office
Facility Name CONVIVA MEDICAL CENTER MANAGEMENT LLC DBA CONVIVA CARE CENTER
Street 480 N STATE RD 7
City PLANTATION
State FL
ZIP 33317
Phone 954 791-9580
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2023
Certificate Expiration Date 11/24/2025
Facility Type Physician Office
Lab Director HEROLD J. MERISIER

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