10D2158097 CLIA NUMBER - CONVIVA MEDICAL CENTER MANAGEMENT LLC DBA CONVIVA CARE CENTER

Laboratory Demographics

  • CLIA Code: 10D2158097
  • Facility Name: CONVIVA MEDICAL CENTER MANAGEMENT LLC DBA CONVIVA CARE CENTER
  • Facility Address: 2020 NE 48TH COURT
    FORT LAUDERDALE, FL
    ZIP 33308
  • Facility Phone: 954 630-0311
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GASTON R. MORAN CELAYES
  • NPI Number: 1164175386
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2158097
LAB Type Physician Office
Facility Name CONVIVA MEDICAL CENTER MANAGEMENT LLC DBA CONVIVA CARE CENTER
Street 2020 NE 48TH COURT
City FORT LAUDERDALE
State FL
ZIP 33308
Phone 954 630-0311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2024
Certificate Expiration Date 11/19/2026
Facility Type Physician Office
Lab Director GASTON R. MORAN CELAYES

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