10D2081001 CLIA NUMBER - BUENA VENTURA LAKES DIALYSIS

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Laboratory Demographics

CLIA Number: 10D2081001

Facility Name: BUENA VENTURA LAKES DIALYSIS

Facility Address:
1998 E OSCEOLA PKWY
KISSIMMEE, FL
ZIP 34743
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Facility Phone Number: 407 348-1271

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1003229766

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2081001
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BUENA VENTURA LAKES DIALYSIS
Street	1998 E OSCEOLA PKWY
City	KISSIMMEE
State	FL
ZIP	34743
Phone	407 348-1271
CertificateType	4
CertificateEffectiveDate	7/17/2022
CertificateExpirationDate	7/16/2024
FacilityType	Waiver

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