10D2174141 CLIA NUMBER - COASTAL PHYSICIANS, LLC

Laboratory Demographics

CLIA Number: 10D2174141

Facility Name: COASTAL PHYSICIANS, LLC

Facility Address:
811 DEL PRADO BLVD S SUITE B
CAPE CORAL, FL
ZIP 33990
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Facility Phone Number: 239 360-2634

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1720648355

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2174141
LAB Type	Physician Office
Facility Name	COASTAL PHYSICIANS, LLC
Street	811 DEL PRADO BLVD S SUITE B
City	CAPE CORAL
State	FL
ZIP	33990
Phone	239 360-2634
CertificateType	4
CertificateEffectiveDate	10/25/2023
CertificateExpirationDate	10/24/2025
FacilityType	Waiver

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