10D2191617 CLIA NUMBER - PINNACLE WELLNESS GROUP LLC

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Laboratory Demographics

CLIA Number: 10D2191617

Facility Name: PINNACLE WELLNESS GROUP LLC

Facility Address:
1680 SE LYNGATE DRIVE SUITE 204
PORT SAINT LUCIE, FL
ZIP 34952
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Facility Phone Number: 772 222-5411

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1780247064

Taxonomy: 207QA0401X - Family Medicine
A family medicine physician who specializes in the diagnosis and treatment of addictions.

CLIA Record

Field Name	Field Value
CLIA Number	10D2191617
LAB Type	Physician Office
Facility Name	PINNACLE WELLNESS GROUP LLC
Street	1680 SE LYNGATE DRIVE SUITE 204
City	PORT SAINT LUCIE
State	FL
ZIP	34952
Phone	772 222-5411
CertificateType	4
CertificateEffectiveDate	8/30/2022
CertificateExpirationDate	8/29/2024
FacilityType	Waiver

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