10D2176347 CLIA NUMBER - DIXITKUMAR N MODI MD PA

Laboratory Demographics

  • CLIA Code: 10D2176347
  • Facility Name: DIXITKUMAR N MODI MD PA
  • Facility Address: 4350 NORTH ATLANTIC AVE
    COCOA BEACH, FL
    ZIP 32931
  • Facility Phone: 334 327-9530
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DIXITKUMAR N. MODI
  • NPI Number: 1124238506
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2176347
LAB Type Physician Office
Facility Name DIXITKUMAR N MODI MD PA
Street 4350 NORTH ATLANTIC AVE
City COCOA BEACH
State FL
ZIP 32931
Phone 334 327-9530
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2023
Certificate Expiration Date 12/11/2025
Facility Type Physician Office
Lab Director DIXITKUMAR N. MODI

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