10D2121793 CLIA NUMBER - SANTURCE MEDICAL CENTER LLC

Laboratory Demographics

CLIA Number: 10D2121793

Facility Name: SANTURCE MEDICAL CENTER LLC

Facility Address:
500 VONDERBURG DR STE 305E
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 624-9399

Facility Type: Other - PATIENT CARE

Certificate Type: Waiver

NPI Number: 1649725029

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	10D2121793
LAB Type	Other - PATIENT CARE
Facility Name	SANTURCE MEDICAL CENTER LLC
Street	500 VONDERBURG DR STE 305E
City	BRANDON
State	FL
ZIP	33511
Phone	813 624-9399
CertificateType	4
CertificateEffectiveDate	11/15/2022
CertificateExpirationDate	11/14/2024
FacilityType	Waiver

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