10D2193589 CLIA NUMBER - LIVE LOVE LIFE INC

Laboratory Demographics

  • CLIA Code: 10D2193589
  • Facility Name: LIVE LOVE LIFE INC
  • Facility Address: 1702 RIDGEWOOD AVE - STE J
    HOLLY HILL, FL
    ZIP 32117
  • Facility Phone: 386 213-5728
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: MARK WALCZYK
  • NPI Number: 1437773280
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2193589
LAB Type Mobile Laboratory
Facility Name LIVE LOVE LIFE INC
Street 1702 RIDGEWOOD AVE - STE J
City HOLLY HILL
State FL
ZIP 32117
Phone 386 213-5728
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type Mobile Laboratory
Lab Director MARK WALCZYK

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