10D2144234 CLIA NUMBER - DE LA VEGA MEDICAL CENTER, LLC

Laboratory Demographics

CLIA Number: 10D2144234

Facility Name: DE LA VEGA MEDICAL CENTER, LLC

Facility Address:
11093 NW 138TH ST STE 121
HIALEAH GARDENS, FL
ZIP 33018
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Facility Phone Number: 786 600-4040

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1861907677

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	10D2144234
LAB Type	Physician Office
Facility Name	DE LA VEGA MEDICAL CENTER, LLC
Street	11093 NW 138TH ST STE 121
City	HIALEAH GARDENS
State	FL
ZIP	33018
Phone	786 600-4040
CertificateType	4
CertificateEffectiveDate	2/13/2024
CertificateExpirationDate	2/12/2026
FacilityType	Waiver

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