10D2179120 CLIA NUMBER - PLANT CITY DERMATOLOGY

Laboratory Demographics

CLIA Number: 10D2179120

Facility Name: PLANT CITY DERMATOLOGY

Facility Address:
502 N MOBLEY ST STE 1
PLANT CITY, FL
ZIP 33563
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Facility Phone Number: 813 498-1933

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1730626656

Taxonomy: 101YA0400X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	10D2179120
LAB Type	Physician Office
Facility Name	PLANT CITY DERMATOLOGY
Street	502 N MOBLEY ST STE 1
City	PLANT CITY
State	FL
ZIP	33563
Phone	813 498-1933
CertificateType	2
CertificateEffectiveDate	6/17/2022
CertificateExpirationDate	6/16/2024
FacilityType	Compliance

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