10D2114779 CLIA NUMBER - SUWANNEE CI SUWANNEE ANNEX SUWANNEE WORK CAMP

Laboratory Demographics

  • CLIA Code: 10D2114779
  • Facility Name: SUWANNEE CI SUWANNEE ANNEX SUWANNEE WORK CAMP
  • Facility Address: 5964 US HWY 90
    LIVE OAK, FL
    ZIP 32060
  • Facility Phone: 386 963-6726
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: LOUIS VAZQUEZ
  • NPI Number: 1609323385
  • Taxonomy: 171100000X - Acupuncturist

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CLIA Record

Field Name Field Value
CLIA Number 10D2114779
LAB Type Prison
Facility Name SUWANNEE CI SUWANNEE ANNEX SUWANNEE WORK CAMP
Street 5964 US HWY 90
City LIVE OAK
State FL
ZIP 32060
Phone 386 963-6726
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2024
Certificate Expiration Date 6/20/2026
Facility Type Prison
Lab Director LOUIS VAZQUEZ

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