10D2189504 CLIA NUMBER - MULBERRY'S MOBILE PROVIDER SERVICES LLC

Laboratory Demographics

CLIA Number: 10D2189504

Facility Name: MULBERRY'S MOBILE PROVIDER SERVICES LLC

Facility Address:
6435 SE US HWY 301
HAWTHORNE, FL
ZIP 32640
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Facility Phone Number: 352 358-8070

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1831683861

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	10D2189504
LAB Type	Physician Office
Facility Name	MULBERRY'S MOBILE PROVIDER SERVICES LLC
Street	6435 SE US HWY 301
City	HAWTHORNE
State	FL
ZIP	32640
Phone	352 358-8070
CertificateType	4
CertificateEffectiveDate	7/31/2022
CertificateExpirationDate	7/30/2024
FacilityType	Waiver

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