10D2131006 CLIA NUMBER - FARDALES MEDICAL CENTER INC

Laboratory Demographics

CLIA Number: 10D2131006

Facility Name: FARDALES MEDICAL CENTER INC

Facility Address:
8051 W 24 AVE STE 9
HIALEAH, FL
ZIP 33016
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Facility Phone Number: 305 400-9702

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174990915

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2131006
LAB Type	Physician Office
Facility Name	FARDALES MEDICAL CENTER INC
Street	8051 W 24 AVE STE 9
City	HIALEAH
State	FL
ZIP	33016
Phone	305 400-9702
CertificateType	4
CertificateEffectiveDate	5/22/2023
CertificateExpirationDate	5/21/2025
FacilityType	Waiver

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