10D2205593 CLIA NUMBER - GREEN MOUNTAIN MED CON INC

Laboratory Demographics

  • CLIA Code: 10D2205593
  • Facility Name: GREEN MOUNTAIN MED CON INC
  • Facility Address: 7925 NW 12TH ST STE 325
    DORAL, FL
    ZIP 33126
  • Facility Phone: 786 580-4957
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLAUDIA FUNDORA
  • NPI Number: 1194330340
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2205593
LAB Type Physician Office
Facility Name GREEN MOUNTAIN MED CON INC
Street 7925 NW 12TH ST STE 325
City DORAL
State FL
ZIP 33126
Phone 786 580-4957
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Physician Office
Lab Director CLAUDIA FUNDORA

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