10D2104867 CLIA NUMBER - LAND O LAKES DIALYSIS

Laboratory Demographics

  • CLIA Code: 10D2104867
  • Facility Name: LAND O LAKES DIALYSIS
  • Facility Address: 2100 VIA BELLA BLVD STE 104
    LAND O LAKES, FL
    ZIP 34639
  • Facility Phone: 813 948-8157
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ALEJANDRO E. CARVALLO
  • NPI Number: 1629447784
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2104867
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAND O LAKES DIALYSIS
Street 2100 VIA BELLA BLVD STE 104
City LAND O LAKES
State FL
ZIP 34639
Phone 813 948-8157
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2023
Certificate Expiration Date 11/12/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ALEJANDRO E. CARVALLO

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