10D2209727 CLIA NUMBER - MAGNOLIA GYNECOLOGY

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Laboratory Demographics

CLIA Number: 10D2209727

Facility Name: MAGNOLIA GYNECOLOGY

Facility Address:
3216 W AZEELE ST STE 2
TAMPA, FL
ZIP 33609
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Facility Phone Number: 813 773-6627

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1063024149

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	10D2209727
LAB Type	Physician Office
Facility Name	MAGNOLIA GYNECOLOGY
Street	3216 W AZEELE ST STE 2
City	TAMPA
State	FL
ZIP	33609
Phone	813 773-6627
CertificateType	4
CertificateEffectiveDate	12/13/2023
CertificateExpirationDate	12/12/2025
FacilityType	Waiver

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