10D2208352 CLIA NUMBER - KETAMINE HEALTH CENTERS AT BONITA SPRINGS LLC

Home > CLIA Lookup > 10D2208352

Laboratory Demographics

CLIA Number: 10D2208352

Facility Name: KETAMINE HEALTH CENTERS AT BONITA SPRINGS LLC

Facility Address:
26800 S TAMIAMI TRAIL SUITE 310
BONITA SPRINGS, FL
ZIP 34134
Get Directions

Facility Phone Number: 239 449-8437

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1518587245

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2208352
LAB Type	Physician Office
Facility Name	KETAMINE HEALTH CENTERS AT BONITA SPRINGS LLC
Street	26800 S TAMIAMI TRAIL SUITE 310
City	BONITA SPRINGS
State	FL
ZIP	34134
Phone	239 449-8437
CertificateType	4
CertificateEffectiveDate	1/6/2023
CertificateExpirationDate	1/5/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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