10D2138180 CLIA NUMBER - PORT ORANGE DIALYSIS

Laboratory Demographics

  • CLIA Code: 10D2138180
  • Facility Name: PORT ORANGE DIALYSIS
  • Facility Address: 3997 S NOVA ROAD
    PORT ORANGE, FL
    ZIP 32127
  • Facility Phone: 386 761-7961
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SAJID LATIF
  • NPI Number: 1568993947
  • Taxonomy: 261QE0700X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 10D2138180
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PORT ORANGE DIALYSIS
Street 3997 S NOVA ROAD
City PORT ORANGE
State FL
ZIP 32127
Phone 386 761-7961
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2025
Certificate Expiration Date 10/11/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SAJID LATIF

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 9/29/2025