10D2095640 CLIA NUMBER - PROVIDENCE COMMUNITY CENTER LLC

Laboratory Demographics

  • CLIA Code: 10D2095640
  • Facility Name: PROVIDENCE COMMUNITY CENTER LLC
  • Facility Address: 5932 NE 2ND AVE
    MIAMI, FL
    ZIP 33137
  • Facility Phone: 305 754-5131
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALPHONSE GILOUX DUFRENY
  • NPI Number: 1457760712
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D2095640
LAB Type Physician Office
Facility Name PROVIDENCE COMMUNITY CENTER LLC
Street 5932 NE 2ND AVE
City MIAMI
State FL
ZIP 33137
Phone 305 754-5131
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2025
Certificate Expiration Date 5/7/2027
Facility Type Physician Office
Lab Director ALPHONSE GILOUX DUFRENY

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