10D2179971 CLIA NUMBER - ALTA MEDICAL LLC

Laboratory Demographics

CLIA Number: 10D2179971

Facility Name: ALTA MEDICAL LLC

Facility Address:
5946 CURRYFORD RD SUITE 103
ORLANDO, FL
ZIP 32822
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Facility Phone Number: 321 667-3641

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346915063

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2179971
LAB Type	Physician Office
Facility Name	ALTA MEDICAL LLC
Street	5946 CURRYFORD RD SUITE 103
City	ORLANDO
State	FL
ZIP	32822
Phone	321 667-3641
CertificateType	4
CertificateEffectiveDate	3/4/2024
CertificateExpirationDate	3/3/2026
FacilityType	Waiver

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