10D2075172 CLIA NUMBER - DG & LEEDS LLC DBA ORLANDO PAIN CLINIC

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Laboratory Demographics

CLIA Number: 10D2075172

Facility Name: DG & LEEDS LLC DBA ORLANDO PAIN CLINIC

Facility Address:
7655 S ORANGE BLOSSOM TRAIL
ORLANDO, FL
ZIP 32809
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Facility Phone Number: 321 280-5052

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1376761031

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2075172
LAB Type	Practitioner Other
Facility Name	DG & LEEDS LLC DBA ORLANDO PAIN CLINIC
Street	7655 S ORANGE BLOSSOM TRAIL
City	ORLANDO
State	FL
ZIP	32809
Phone	321 280-5052
CertificateType	4
CertificateEffectiveDate	3/24/2024
CertificateExpirationDate	3/23/2026
FacilityType	Waiver

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