10D2117577 CLIA NUMBER - CONVIVA MEDICAL CENTER MANAGEMENT, LLC DBA CONVIVA CARE CENTER

Laboratory Demographics

  • CLIA Code: 10D2117577
  • Facility Name: CONVIVA MEDICAL CENTER MANAGEMENT, LLC DBA CONVIVA CARE CENTER
  • Facility Address: 7901 PALM RIVER ROAD
    TAMPA, FL
    ZIP 33619
  • Facility Phone: 813 626-0066
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANGELA Y. ROSS-JOHNSON
  • NPI Number: 1881031425
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2117577
LAB Type Physician Office
Facility Name CONVIVA MEDICAL CENTER MANAGEMENT, LLC DBA CONVIVA CARE CENTER
Street 7901 PALM RIVER ROAD
City TAMPA
State FL
ZIP 33619
Phone 813 626-0066
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2024
Certificate Expiration Date 8/18/2026
Facility Type Physician Office
Lab Director ANGELA Y. ROSS-JOHNSON

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