10D2174292 CLIA NUMBER - PRIMARY CARE 369, LLC

Laboratory Demographics

CLIA Number: 10D2174292

Facility Name: PRIMARY CARE 369, LLC

Facility Address:
9980 CENTRAL PARK BLVD STE 314
BOCA RATON, FL
ZIP 33428
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Facility Phone Number: 561 404-1699

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1760034300

Taxonomy: 261QP2300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	10/29/2023
CertificateExpirationDate	10/28/2025
FacilityType	Waiver

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