10D2123378 CLIA NUMBER - REVIVAL RESEARCH CORPORATION

Laboratory Demographics

CLIA Number: 10D2123378

Facility Name: REVIVAL RESEARCH CORPORATION

Facility Address:
8200 NW 27TH STREET STE 116
DORAL, FL
ZIP 33122
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Facility Phone Number: 305 505-3912

Facility Type: Other - MEDICAL RESEARCH

Certificate Type: Waiver

NPI Number: 1720598303

Taxonomy: 261QR1100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2123378
LAB Type	Other - MEDICAL RESEARCH
Facility Name	REVIVAL RESEARCH CORPORATION
Street	8200 NW 27TH STREET STE 116
City	DORAL
State	FL
ZIP	33122
Phone	305 505-3912
CertificateType	4
CertificateEffectiveDate	12/20/2022
CertificateExpirationDate	12/19/2024
FacilityType	Waiver

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