10D2114000 CLIA NUMBER - CASTELLANO COSMETIC SURGERY

Laboratory Demographics

CLIA Number: 10D2114000

Facility Name: CASTELLANO COSMETIC SURGERY

Facility Address:
105 S MACDILL AVE STE 203
TAMPA, FL
ZIP 33609
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Facility Phone Number: 813 872-6093

Facility Type: Other - OFFICE BASED SURGERY

Certificate Type: Waiver

NPI Number: 1083912695

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2114000
LAB Type	Other - OFFICE BASED SURGERY
Facility Name	CASTELLANO COSMETIC SURGERY
Street	105 S MACDILL AVE STE 203
City	TAMPA
State	FL
ZIP	33609
Phone	813 872-6093
CertificateType	4
CertificateEffectiveDate	6/6/2022
CertificateExpirationDate	6/5/2024
FacilityType	Waiver

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