10D2099259 CLIA NUMBER - MANUEL D GONZALEZ MD PA

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Laboratory Demographics

CLIA Number: 10D2099259

Facility Name: MANUEL D GONZALEZ MD PA

Facility Address:
1127 NW 22ND AVE
MIAMI, FL
ZIP 33125
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Facility Phone Number: 305 649-6111

Facility Type: Other - HCC

Certificate Type: Waiver

NPI Number: 1184756108

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2099259
LAB Type	Other - HCC
Facility Name	MANUEL D GONZALEZ MD PA
Street	1127 NW 22ND AVE
City	MIAMI
State	FL
ZIP	33125
Phone	305 649-6111
CertificateType	4
CertificateEffectiveDate	7/23/2023
CertificateExpirationDate	7/22/2025
FacilityType	Waiver

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