10D2085032 CLIA NUMBER - SOMA MEDICAL CENTER MD PA #6

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Laboratory Demographics

CLIA Number: 10D2085032

Facility Name: SOMA MEDICAL CENTER MD PA #6

Facility Address:
3580 LAKE WORTH RD
LAKE WORTH, FL
ZIP 33461
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Facility Phone Number: 561 598-4105

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1609449362

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2085032
LAB Type	Physician Office
Facility Name	SOMA MEDICAL CENTER MD PA #6
Street	3580 LAKE WORTH RD
City	LAKE WORTH
State	FL
ZIP	33461
Phone	561 598-4105
CertificateType	4
CertificateEffectiveDate	10/7/2022
CertificateExpirationDate	10/6/2024
FacilityType	Waiver

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