10D2167678 CLIA NUMBER - LAKEWOOD CCL, LLC

Laboratory Demographics

  • CLIA Code: 10D2167678
  • Facility Name: LAKEWOOD CCL, LLC
  • Facility Address: 5571 E SR 44 SUITE 502
    WILDWOOD, FL
    ZIP 34785
  • Facility Phone: 352 643-9070
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: VINOD R. MIRYALA
  • NPI Number: 1922575802
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2167678
LAB Type Physician Office
Facility Name LAKEWOOD CCL, LLC
Street 5571 E SR 44 SUITE 502
City WILDWOOD
State FL
ZIP 34785
Phone 352 643-9070
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 1/17/2024
Certificate Expiration Date 1/16/2026
Facility Type Physician Office
Lab Director VINOD R. MIRYALA

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