10D2126020 CLIA NUMBER - V AND R MEDICAL GROUP INC DBA LA QUINTA #1 MEDICAL CENTER

Laboratory Demographics

CLIA Number: 10D2126020

Facility Name: V AND R MEDICAL GROUP INC DBA LA QUINTA #1 MEDICAL CENTER

Facility Address:
1923 W 60 ST
HIALEAH, FL
ZIP 33012
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Facility Phone Number: 786 420-2074

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1073925236

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	10D2126020
LAB Type	Physician Office
Facility Name	V AND R MEDICAL GROUP INC DBA LA QUINTA #1 MEDICAL CENTER
Street	1923 W 60 ST
City	HIALEAH
State	FL
ZIP	33012
Phone	786 420-2074
CertificateType	4
CertificateEffectiveDate	2/17/2023
CertificateExpirationDate	2/16/2025
FacilityType	Waiver

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