10D2234595 CLIA NUMBER - COASTLINE IMAGING LLC

Laboratory Demographics

  • CLIA Code: 10D2234595
  • Facility Name: COASTLINE IMAGING LLC
  • Facility Address: 2290 W EAU GALLIE BLVD SUITE 104
    MELBOURNE, FL
    ZIP 32935
  • Facility Phone: 321 253-2700
  • Facility Type: Other - IDTF
  • Facility Type: Waiver
  • Lab Director: LAURA M. KASSA
  • NPI Number: 1770576167
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 10D2234595
LAB Type Other - IDTF
Facility Name COASTLINE IMAGING LLC
Street 2290 W EAU GALLIE BLVD SUITE 104
City MELBOURNE
State FL
ZIP 32935
Phone 321 253-2700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2025
Certificate Expiration Date 8/31/2027
Facility Type Other - IDTF
Lab Director LAURA M. KASSA

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