10D2213610 CLIA NUMBER - 71120 VENTURES, LLC

Laboratory Demographics

  • CLIA Code: 10D2213610
  • Facility Name: 71120 VENTURES, LLC
  • Facility Address: 326 DEL PRADO BOULEVARD, NORTH SUITE 101
    CAPE CORAL, FL
    ZIP 33909
  • Facility Phone: 239 689-7854
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: GAUTHAM MOGILISHETTY
  • NPI Number: 1205411154
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2213610
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name 71120 VENTURES, LLC
Street 326 DEL PRADO BOULEVARD, NORTH SUITE 101
City CAPE CORAL
State FL
ZIP 33909
Phone 239 689-7854
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/15/2025
Certificate Expiration Date 2/14/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director GAUTHAM MOGILISHETTY

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