10D2174292 CLIA NUMBER - PRIMARY CARE 369, LLC

Laboratory Demographics

  • CLIA Code: 10D2174292
  • Facility Name: PRIMARY CARE 369, LLC
  • Facility Address: 9980 CENTRAL PARK BLVD STE 314
    BOCA RATON, FL
    ZIP 33428
  • Facility Phone: 561 404-1699
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GAYATRI SIRAM
  • NPI Number: 1760034300
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2174292
LAB Type Physician Office
Facility Name PRIMARY CARE 369, LLC
Street 9980 CENTRAL PARK BLVD STE 314
City BOCA RATON
State FL
ZIP 33428
Phone 561 404-1699
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2023
Certificate Expiration Date 10/28/2025
Facility Type Physician Office
Lab Director GAYATRI SIRAM

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