10D2135592 CLIA NUMBER - BERMUDEZ MEDICAL GROUP LLC

Laboratory Demographics

CLIA Number: 10D2135592

Facility Name: BERMUDEZ MEDICAL GROUP LLC

Facility Address:
2601 DAVIE BLVD
FORT LAUDERDALE, FL
ZIP 33312
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Facility Phone Number: 754 216-2458

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1700396637

Taxonomy: 207QA0505X - Family Medicine
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.

CLIA Record

Field Name	Field Value
CLIA Number	10D2135592
LAB Type	Physician Office
Facility Name	BERMUDEZ MEDICAL GROUP LLC
Street	2601 DAVIE BLVD
City	FORT LAUDERDALE
State	FL
ZIP	33312
Phone	754 216-2458
CertificateType	4
CertificateEffectiveDate	8/24/2023
CertificateExpirationDate	8/23/2025
FacilityType	Waiver

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