10D2110115 CLIA NUMBER - KIMBERLY REGENESIS

Laboratory Demographics

  • CLIA Code: 10D2110115
  • Facility Name: KIMBERLY REGENESIS
  • Facility Address: 6290 CORPORATE COURT SUITE C201
    FORT MYERS, FL
    ZIP 33919
  • Facility Phone: 239 222-0700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARY M. MOURACADE
  • NPI Number: 1629127188
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D2110115
LAB Type Physician Office
Facility Name KIMBERLY REGENESIS
Street 6290 CORPORATE COURT SUITE C201
City FORT MYERS
State FL
ZIP 33919
Phone 239 222-0700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2024
Certificate Expiration Date 3/8/2026
Facility Type Physician Office
Lab Director MARY M. MOURACADE

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