10D2079629 CLIA NUMBER - LAKE MARY DIALYSIS

Laboratory Demographics

  • CLIA Code: 10D2079629
  • Facility Name: LAKE MARY DIALYSIS
  • Facility Address: 39 SKYLINE DR STE 1001
    LAKE MARY, FL
    ZIP 32746
  • Facility Phone: 407 833-8667
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: IVAN D. MAYA
  • NPI Number: 1083031223
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2079629
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAKE MARY DIALYSIS
Street 39 SKYLINE DR STE 1001
City LAKE MARY
State FL
ZIP 32746
Phone 407 833-8667
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/19/2024
Certificate Expiration Date 6/18/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director IVAN D. MAYA

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