10D2219746 CLIA NUMBER - COTG2021

Laboratory Demographics

  • CLIA Code: 10D2219746
  • Facility Name: COTG2021
  • Facility Address: 1220 PROSPECT AVE SUITE 294
    MELBOURNE, FL
    ZIP 32901
  • Facility Phone: 321 327-7481
  • Facility Type: Mobile Laboratory
  • Facility Type: Certificate of Compliance
  • Lab Director: ANDREW G. GROSSMAN
  • NPI Number: 1396326807
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 10D2219746
LAB Type Mobile Laboratory
Facility Name COTG2021
Street 1220 PROSPECT AVE SUITE 294
City MELBOURNE
State FL
ZIP 32901
Phone 321 327-7481
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 11/3/2023
Certificate Expiration Date 11/2/2025
Facility Type Mobile Laboratory
Lab Director ANDREW G. GROSSMAN

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