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10D2211730 CLIA NUMBER - DOCTORS DIET PROGRAM OF SOUTH FLORIDA

Laboratory Demographics

CLIA Number: 10D2211730

Facility Name: DOCTORS DIET PROGRAM OF SOUTH FLORIDA

Facility Address:
6800 N DALE MABRY HWY #186
TAMPA, FL
ZIP 33614
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Facility Phone Number: 813 839-3438

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1043718034

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name Field Value
CLIA Number 10D2211730
LAB Type Physician Office
Facility Name DOCTORS DIET PROGRAM OF SOUTH FLORIDA
Street 6800 N DALE MABRY HWY #186
City TAMPA
State FL
ZIP 33614
Phone 813 839-3438
CertificateType 4
CertificateEffectiveDate 1/29/2023
CertificateExpirationDate 1/28/2025
FacilityType Waiver

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