10D2165696 CLIA NUMBER - PRESTIGE PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 10D2165696
  • Facility Name: PRESTIGE PRIMARY CARE LLC
  • Facility Address: 1855 VETERANS PARK DRIVE SUITE 304
    NAPLES, FL
    ZIP 34109
  • Facility Phone: 443 366-1644
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MAHESHA THIMMARAYAPPA
  • NPI Number: 1225505399
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2165696
LAB Type Physician Office
Facility Name PRESTIGE PRIMARY CARE LLC
Street 1855 VETERANS PARK DRIVE SUITE 304
City NAPLES
State FL
ZIP 34109
Phone 443 366-1644
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2025
Certificate Expiration Date 5/2/2027
Facility Type Physician Office
Lab Director MAHESHA THIMMARAYAPPA

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